Timely access to community health services reduces pressure on elective care and urgent and emergency care.
It helps people to return to work or school more quickly and supports the shift from hospital to community care set out in the 10 Year Health Plan.
The NHS oversight framework includes a community health service waiting times delivery metric and the Medium term planning framework sets a national ambition for 80% of community health service waits to be less than 18 weeks by the end of 2028/29, with systems also expected to have clear plans to eliminate waits of more than 52 weeks.
The 18-week target does not supersede clinical standards for community health services pathways.
This guidance supports systems to meet the Year 1 objective of 78% of waits being under 18 weeks by the end of 2026/27.
The community health services waiting times action lists in Annex 1 build on these recommendations, outlining ‘core’ and ‘going further’ activity that should be considered as part of improvement work.
Supporting people waiting for community health services
Systems should make sure that patients waiting for community health services are signposted to help and supportive resources.
Where clinically appropriate, this might include self-management support such as:
- written information
- group workshops
- online courses
- local voluntary, community and social enterprise (VCSE) offers
- peer support groups
Systems should oversee clinical harm review arrangements and evaluate the impact of long waiting times on people waiting for community health services.
Effective triage processes and clinical prioritisation tools should be used to help identify patients at higher risk of negative outcomes, who may require more urgent care, additional monitoring or support while waiting.
Targeting community health service lines
While the Medium term planning framework targets are not focused on any particular age group, early progress in reducing 18-week waits is likely to be achieved through a focus on adult service lines, particularly the high-volume community musculoskeletal (MSK) service line.
This is a cross-government priority, with the Department for Work and Pensions and Department of Health and Social Care jointly funding the GIRFT MSK Community Delivery Programme, which is supporting systems to improve quality and accessibility of community MSK services and to improve health and work outcomes for people with an MSK condition.
Priority should be given to reducing the longest waiting times, with clear local ambitions for measurable improvements in waits of more than 52 weeks.
The longest community health service waits are largely concentrated in children and young people service lines and addressing these will require sustained, long-term effort.
Plans to eliminate waits exceeding 52 weeks should therefore include targeted action to reduce waiting times for children and young people and support those who are waiting.
Data improvement
Organisations should continue to improve the quality of community waiting times data in the Community health services SitRep, ensuring that this data is validated and complete.
High quality data is critical to measuring performance effectively and to targeting improvement work.
Integrated care boards (ICBs) should continue to support the rollout of community faster data flows (FDF) in line with the NHS Community Health Services Data Plan.
Productivity
The Medium term planning framework asks ICBs and community health providers to identify and act on productivity opportunities (productivity metrics have been developed and growth metrics are reported in a monthly publication).
ICBs and providers should look to improve appointment management and consider introducing high-impact appointments (including group clinics and assessment days) to increase capacity in high-demand pathways. This builds on learning from the GIRFT Community Delivery Programme.
Digital strategies to improve clinical productivity and help patients manage their conditions more effectively should be considered, including:
- digital patient records
- voice dictation software
- AI tools for summarising and creating clinic letters
- self-management apps
- websites that provide easy access to information and resources
In parallel, the implementation of patient-initiated follow-up (PIFU) and supported self-management (where clinically appropriate and operationally feasible) will release capacity and enable more timely access to care.
Systems should work closely with health and care partners in line with the Neighbourhood health guidelines, and for children and young people, work with Best Start Family Hubs.
This will improve patient flow, deliver early interventions, avoid multiple referrals and duplication, and help individual clinicians and professionals respond to complex needs.
Health inequalities
Improvement work must include consideration of its impact on health inequalities and should aim to reduce disparities while improving waiting times and quality of care.
This work must be reviewed to assess its impact on access and health inequalities and should align with national health inequality improvement approaches, including Core20PLUS5.
Support
NHS England will provide guidance and resources to help deliver the recommendations in this action plan.
The community health services waiting times action lists in Annex 1 will help systems assess what they are currently doing and identify opportunities for improvement.
The Standardising community health services publication will help systems design, commission and deliver community health services.
Colleagues involved in delivering community services should sign up to the FutureNHS community health services page (login required) and to regional FutureNHS pages for more support and resources.
Annex 1: Community health services waiting times action lists
The Medium term planning framework sets national targets to reduce waiting times for community health services: for 78% of community health services waits to be less than 18 weeks by the end of 2026/27 and 80% to be less than 18 weeks by the end of 2028/29 – and for systems to develop a plan to eliminate waits exceeding 52 weeks.
The action lists below will support attainment of these targets and are designed to be used alongside existing 2026/27 ICB and provider plans.
They build on learning from the GIRFT Further Faster Community MSK Services Handbook and will help systems assess current activity and guide where they can improve.
The lists include links to case studies and relevant guidance.
We have also included a downloadable checklist in Word format to help you track compliance across action lists 1 to 4.
How to use the action lists
The Standardising community health services publication provides information on the core community health services that ICBs, providers and partners should consider when planning services for their local populations.
These action lists are not focused on specific age groups or service lines but can be adapted to reflect service line and local needs.
We expect to publish service line-specific versions of the action lists on the Community Waiting Times FutureNHS platform in the future and will be prioritising the service lines with the longest waits.
There are 4 action lists:
- Effective waiting list management
- Productivity
- Appointment management
- Supporting people waiting for community health services
Each action list is split into ‘core activity’ and ‘going further’ activity.
- Core activity outlines the minimum standards and actions required to reduce and maintain community health service waiting lists, improve wellbeing while people wait and improve outcomes for people receiving community health service interventions.
- Going further activity refers to additional actions that have been shown to help reduce waiting times, but which should only be considered once the core activity is being delivered effectively.
The action lists include links to guidance for other settings (elective and primary care) where these approaches apply to community health services.
This includes, for example, the use of group clinics where clinically appropriate.
The guidance referenced in the action lists will be updated as evidence develops.
Action list 1: Effective waiting list management
Good waiting list management, supported by regular validation, reduces waiting times.
It ensures lists are accurate, prioritised, and focused on patients who still need care.
By removing duplicate or inappropriate entries, confirming ongoing clinical need, and improving scheduling efficiency, organisations can free up capacity, streamline patient flow, and target resources where they are most needed.
Core activities
1.1 Submit monthly, accurate, provider-level data to the NHS England Community Health Services Situation Report (SitRep) on waiting times for community health services; ensuring:
- the SitRep technical guidance is adhered to
- monthly, accurate data is being reported to the SitRep
- waiting times are being reported into the appropriate data set (for example, neurodevelopmental assessments are reported into mental health data sets when delivered under a CAMHS service)
- data quality is reviewed quarterly, ensuring submissions align with locally collected waiting times data and investigating any data spikes to ensure accuracy and quality
- that, where services show significant changes in waiting list size or waiting times, internal processes are used to verify these changes before SitRep submission. Upon submission, any significant changes from previous returns should be escalated
Relevant guidance and support:
- Community Health Services SitRep technical specification (NHS England)
1.2 Review the pathway for transition of care from children and young people’s services to adulthood, and make sure the transfer of service provision is mapped
Relevant guidance and support:
1.3 Complete quarterly data validation (technical and administrative) exercises:
- ensure that all services have published referral criteria, which are regularly reviewed and shared with referrers
- remove duplicate referrals or duplicate patient pathways
- identify patients already receiving care within the service or no longer requiring intervention and remove them from waiting lists
- this includes patients who may have received treatment or interventions from the independent sector
- contact patients (and parents or carers) using their preferred communication method to ask if they wish to continue with care and direct them to self-management resources while they are waiting
If patients say they no longer want to be seen, they can be removed from the waiting list if they have capacity, understand the decision they are making and have had all their communication needs met.
Patients should not be removed from the waiting list if a communication need has not been assessed or met.
Relevant guidance and support:
1.4 Complete quarterly clinical validation exercises:
- ensure all referrals meet the threshold to receive service interventions
- review whether the patient can be managed through supported self-management resources (where clinically appropriate)
- review cases where multiple referrals have been made to a single service to determine whether they can be managed within one pathway
- apply risk stratification frameworks where there is increased risk of harm or downstream need from longer waiting times
- use validated tools where clinically appropriate and operationally feasible for the service line
- prioritise patients whose condition is at risk of deteriorating or who require urgent interventions
- prioritise patients waiting over 104 and 52 weeks
- consider using patient-routing tools to ensure patients are seen by the most appropriate clinician or team member at first contact
Relevant guidance and support:
1.5 Review service line referral processes:
- review consistency and compliance with referral criteria
- review and remove any unnecessary administration, where possible (using lean, kaizen or other process mapping techniques)
- streamline methods of recording referrals by implementing digital referral management systems.
Relevant guidance and support:
- Guidance: Referral management plan – NHS e-Referral Service (NHS England)
- Webpage: NHS Community Health Services Data Plan, 2024/25 to 2026/27 (NHS England)
1.6 Services must report progress on improvement work to their accountable board;
They must describe actions, mitigations, impact, learning, and next steps;
Where services are not on track to meet targets, boards should receive reports that explicitly set out and explain the recovery actions.
Going further activity
1.7 Implement digital tools to support validation of waiting lists
1.8 Weekly waiting list validation to ensure data accuracy, early identification of patients no longer requiring intervention and clinical prioritisation
Relevant guidance and support:
1.8 Local waiting list data should be linked with demographic information on the wider determinants of health (such as socio-economic status, ethnicity, and gender);
Use this to support waiting list management and targeted engagement with communities at risk of unequal access
Relevant guidance and support:
Download the checklist to track compliance across action lists 1 to 4 (Microsoft Word format).
Action list 2: Productivity
Improving productivity increases capacity and reduces pressure on waiting lists.
Teams can free up clinical time while maintaining or improving quality by reprioritising work, using patient- and clinician-reported measures to target service improvements and supporting patient self-management.
Digital tools and high-impact appointment models can also improve efficiency by reducing the number of contacts in a pathway (where clinically appropriate) and making each clinical interaction count.
Core activity
2.1 Map the workforce, including skill mix and vacancies, and identify where a different workforce model could release specialist capacity and make best use of clinical or specialist skills and experience
2.2 Routinely collect patient reported outcome measures, patient recorded experience measures (where available) and clinician reported measures and use these to inform quality evaluation and improvement.
Relevant guidance and support:
- Guidance: Experience of care improvement self-assessment (NHS England)
- Guidance: Patient experience in adult NHS services: improving the experience of care for people using adult NHS services (NICE clinical guideline CG138)
- Guidance: Babies, children and young people’s experience of healthcare (NICE guideline NG204)
2.3 Work with alternative settings (including voluntary, community and social enterprise groups) to create capacity in a variety of community venues
2.4 Implement patient initiated follow up (PIFU) where clinically appropriate and operationally feasible and build this into service reporting
Relevant guidance and support:
- Guidance: Implementing patient initiated follow-up: guidance for local health and care systems (NHS England)
Going further activity
2.5 Support patient self-management with evidence-based approaches to peer support, self-management education and health coaching
Relevant guidance and support:
- Guidance: Supported self-management (NHS England)
2.6 Offer clinical assessment or appointment days where clinically appropriate and consider opportunities to involve other partners including the voluntary sector
Relevant guidance and support:
2.7 Offer group clinics;
Group clinics are widely used in primary care and increasingly part of community health service delivery
Relevant guidance and support:
2.8 Where clinically appropriate and operationally feasible, use digital tools to improve productivity;
For example:
- ambient voice technology
- digital management systems to automate triage, route patients to the most appropriate professional for their appointment and support self-management
- technology to support telehealth appointments
- digital screening and triage tools
- patient communication portals and record sharing tools
- digital interventions or therapies that release capacity
Services must consider how introducing a digital tool will affect service accessibility for all patients.
Relevant guidance and support:
- Guidance: Guidance on the use of AI-enabled ambient scribing products in health and care settings (NHS England)
2.9 Apply statistical process control techniques to understand local variations in waiting list data and the impact of improvement approaches;
Use recognised service improvement methods (for example, quality, service improvement and redesign [QSIR]) to support productivity improvement
Relevant guidance and support:
- Webpage: Statistical process control tool (NHS England)
Download the checklist to track compliance across action lists 1 to 4 (Microsoft Word format).
Action list 3: Appointment management
Effective appointment management can help reduce waiting lists by making sure referrals into community services are appropriate and clinically suitable.
This directs patients to the right services and removes unnecessary referrals.
It helps patients prepare for their appointments, increases engagement and improves the quality of each contact.
Understanding the reasons behind ‘did not attend’ (DNA) rates allows services to address barriers, improve communication, and reduce missed appointments.
Core activity
3.1 Communication methods must take account of patients, carers and others who have communication support needs;
This includes people with disabilities, impairments or sensory loss, people with limited English, and people who have difficulty reading;
Communications must reach people who don’t have access to smartphones or emails
Relevant guidance and support:
- Guidance: Good communication with patients waiting for care: core principles (NHS England)
- Guidance: Accessible Information Standard (NHS England)
3.2 Ensure all referrals into community services are appropriate:
- provide referrers (including self-referring patients) with information about conditions and relevant services, so community services are only used when necessary and clinically appropriate and when they cannot be managed in a primary care setting, through supported self-management or in other settings such as community pharmacy
- give GPs and other referring professionals information about the local services available (for example, diagnostics) so that referred patients go to the right place at the right time
- set out clear referral criteria for services
- if a referral is rejected, clearly explain why (for example, that the patient does not meet the threshold for intervention)
Relevant guidance and support:
- Guidance: Advice and guidance (NHS England)
- Guidance: Supported self-management (NHS England)
3.3 Provide attendance support to help prepare patients for appointments:
- give clear, concise information about what the appointment is for and how the patient should prepare, particularly if it is a remote appointment
- confirm the patient’s phone number before telephone appointments and explain how they can update their number if they change it
- tell patients what equipment they will need for video appointments and how to set this up to get the most out of the appointment
- send appointment reminders (texts, calls or letters) to patients before their appointment
Relevant guidance and support:
- Guidance: Video consulting with your NHS: guides for patients, staff and trusts (NHS England)
- Guidance: Good communication with patients waiting for care: core principles (NHS England)
3.4 Implement robust ‘did not attend’ (DNA) and ‘was not brought’ (WNB) management in line with local access policies;
Ensure that:
- DNA and WNB rates are monitored routinely
- DNA and WNB audits are conducted regularly to understand why people are not attending. For children and young people, contact the family to understand why they were not brought and consider reasonable adjustments to support attendance
- patients have reasonable rebooking options, where appropriate
- capacity is safely released by promptly discharging patients from services in line with access policies and notifying their referrers
Relevant guidance and support:
- Guidance: Reducing ‘did not attends’ (DNAs) in outpatient services (NHS England)
Going further activity
3.5 Review booking processes annually to make sure they are effective and patients find them easy to use
3.6 Offer virtual or telephone consultations where requested and clinically appropriate;
Where possible, give patients a choice about where they are seen
3.7 Consider expanding service hours, including providing evening or weekend appointments when this is operationally feasible
3.8 Maintain a list of patients who can be seen at short notice to fill last-minute cancellations
3.9 Carry out quarterly reviews of clinic slot utilisation, with a target of 95% utilisation;
Use analysis of DNA and WNB rates to inform planning and maximise clinical capacity
3.10 Review the notes of DNA or WNB patients and try to contact them to communicate next steps
3.11 Review new to follow-up ratios in services to identify pathway inefficiencies and opportunity to use clinic slots more effectively
3.12 Shared decision making (SDM): Help patients to understand their care, treatment and support options, including the risks, benefits and outcomes of these options
Relevant guidance and support:
- Guidance: Shared decision making: summary guide (NHS England)
Download the checklist to track compliance across action lists 1 to 4 (Microsoft Word format).
Action list 4: Supporting people waiting for community health services
4.1 Share information with the referrer at the point of referral to community health services, including details of the support available for patients while they wait
4.2 Take action to reduce health inequalities affecting people needing to access community health services and align this action with the NHS strategic priorities in this area
Relevant guidance and support:
- Guidance: Core20PLUS5 (adults) – an approach to reducing healthcare inequalities (NHS England)
- Guidance: Core20PLUS5 – an approach to reducing health inequalities for children and young people (NHS England)
- Guidance: Addressing health inequalities across allied health professional (AHP) services: a guide for AHP system leaders (Office for Health Improvement and Disparities)
4.3 Share support and resources at the point of referral to help the patient self-manage conditions while waiting;
Review these regularly to make sure they are clear, accessible and relevant
4.4 Communicate clear, up-to-date information on how to access local voluntary, community and social enterprise (VCSE) services
4.5 Monitor risk for patients on waiting lists routinely, using risk-profiling to prioritise referrals appropriately;
This should consider:
- the clinical risks of prolonged waiting times
- the risks of being signed off from work
- the risk to school attendance and educational attainment
- the impact on emotional wellbeing and mental health
4.6 Integrate local talking therapies and social prescribing services with services so they are available to patients experiencing anxiety and depression related to their wait or condition
Relevant guidance and support:
- Guidance: NHS Talking Therapies for anxiety and depression (NHS England)
4.7 Develop personalised care and support plans with patients, including clear guidance on how to escalate and who to escalate to if their condition deteriorates;
Share plans with relevant partners and agencies
Relevant guidance and support:
- Guidance: Personalised care and support planning (NHS England)
Going further activity
4.8 Use social prescribing pathways proactively and review them regularly to ensure patients are signposted to appropriate community-based support
Relevant guidance and support:
- Webpage: Social prescribing (NHS England)
4.9 Develop a provider harms policy, with clear board oversight and escalation routes
Download the checklist to track compliance across action lists 1 to 4 (Microsoft Word format).
Publication reference: PRN02287_i