Date published: 30 January, 2025
Date last updated: 30 January, 2025
Planning guidance

Our new operating model: supporting you to deliver high quality care for patients

In this document, we describe how we will support ICBs and providers to deliver what the NHS is being asked to do through the Mandate from government and the 2025/26 priorities and operational planning guidance. It sets out how we will work with you to deliver these priorities, while living within the resources available and continuing to lay the foundations for future reforms the 10 Year Health Plan will set out. It also describes what practical tools and guidance documents you can expect from NHS England and when.

Following the pandemic and 2 major successive merger programmes, we can now focus more closely on how we best support you to deliver high quality care for patients. A summary of our functions is here on our website.

This is the first step towards a genuine shift in the way we work together, which we will develop with you over the coming months.

1. How we will help you plan for 2025/26

You have consistently told us you want to move from planning to delivery as soon as possible, which will also help you to achieve efficiency savings, and productivity and quality improvements across the full year. We are therefore putting more emphasis on getting alongside you to develop effective plans, rather than asking you to resubmit multiple versions.

We want to reduce the amount of iteration and negotiation and instead have honest discussions – within the NHS and with local partners and stakeholders – on where resources and our support should be focused.

A. Providing the data and systems you need to support decision-making

  • Across NHS England, systems and providers, we have a wealth of data available to us. We haven’t always used this in a systematic and standardised way, and we will work with you to achieve this, including making best use of the NHS Federated Data Platform which we cover in section 3. Some of the products already available to help you make best use of data include:
    • the Model Health System, which brings together many of our central data and analytical insights to support you to reduce variation and improve productivity. We will work with you to improve it, and support you to make best use of the insights it provides to shape your local services
    • the Insightful Board series, which helps ICB and provider boards to use their data to underpin decision-making
    • the data packs we have shared with you, which consolidate the productivity, efficiency and improvement opportunities relevant to your system and will help to make your plans as ambitious as possible, while using the NHS Spend Comparison Service to identify potential savings on goods and services

B. Simplifying the planning process

  • The national timetable and approach to planning this year aims to support ICBs and providers to develop and submit robust, triangulated and deliverable operational, workforce and finance plans, signed off by provider and ICB boards by the end of March 2025.
  • NHS England has reduced the number of returns, putting more emphasis on high quality conversations. A headline plan will need to be submitted on 27 February and a full plan on 27 March.
  • NHS England regional teams will support ICBs and providers while they develop their plans, co-ordinate input from national teams where appropriate, and lead on NHS England’s assurance of plans – meeting our commitment to provide you with aligned feedback.
  • Our regional teams will support ICBs to work together on the planning of services which need to be delivered across populations larger than individual ICBs. 
  • From the outset, we are emphasising that all systems must live within their means and plan for and deliver a balanced net system financial position.

C. Agreeing plans

  • Building on what we have done previously, we will have a Board-to-Board meeting with NHS England and systems (ICBs plus provider chief executives and chairs, and other partners) once the plan has been submitted.
  • In this meeting, a compact will be agreed between NHS England and each system, setting out what each organisation is committing to deliver, how and by when. The compact will reflect the local context and support requested, and what each system partner will be accountable for. This will be directly linked to the NHS Improvement and Assessment Framework, and we will regularly review the compact with each organisation (see below).

2. How we will assess, oversee and work with you in 2025/26

The new NHS Improvement and Assessment Framework, which we will share with you shortly, will set out how we will assess providers and ICBs’ performance, taking a whole system view. That assessment will be the starting point for how we work with you throughout the year, and it will determine how we can support you to improve. It will outline the increased autonomy the top-performing organisations can expect to receive.

Regional directors and their teams will lead on co-ordinating our offers to systems, commissioning what they need from their national colleagues. They will work with their teams to monitor in-year delivery of system plans, performance metrics and the outcomes providers and systems are achieving. National directors and their teams will continue to set strategy and overall direction and provide regional colleagues with the expert analysis and best practice they need to support you to deliver your plans.  

Discussions about performance will be led by colleagues at NHS England who have experience of addressing delivery challenges, with a focus on offering you practical, informed evidence and guidance that is grounded in a deep understanding of the operational challenges you face.

Our ambition is to see self-managing and self-improving systems across the country. Where performance falls below an acceptable standard or there are governance concerns about an ICB or a provider, NHS England will step in earlier and may consider using regulatory powers to secure improvement. When we do this, we will do so in a transparent and consistent way.

We want to fully implement this model by this summer, which will also help to address the friction points that often get raised by leaders. In doing so, we are committed to:

  • streamlining oversight: providing consistent and co-ordinated oversight to reduce duplication and prevent providers from being bombarded with conflicting instructions
  • focusing on performance improvement: supporting providers to achieve sustainable improvement by prioritising actionable must-dos and offering constructive challenge to drive positive outcomes
  • strengthening systems and infrastructure: providing data tools and platforms which enable local analyses to drive informed decision-making, continuous improvement and effective performance management
  • fostering collaboration and trust: engaging with providers, ICBs and stakeholders in a way which builds trust and alignment so that shared goals are achieved in an efficient way
  • embedding sustainable local practices: working collaboratively on improvements that can be managed and embedded locally, minimising the reliance on external interventions or support

3. How we will support you throughout 2025/26

A. Access to more detailed information

If boards and frontline teams have reliable information, they can focus their resources and attention on performance and productivity improvement. Effective planning and delivery conversations are built on high quality data and insight.

To support system and trust productivity efforts, as part of a commitment to a greater focus on developing information and tools to support the development of community services, we have funded and provided access to 4 core NHS Federated Data Platform (FDP) products for all organisations to deliver elective care reform, as set out in our recent plan, and patient flow. These products will help local leaders to manage their Referral to Treatment pathways by providing data insights and tools to improve theatre utilisation, support scheduling, enhance data quality, and manage waiting lists more effectively, as well as a specific tool for discharge planning. Together these products help local teams to free up hospital beds, improve patient flow and deliver the 2025/26 priorities. We are providing each ICB and provider with their own local FDP alongside access to the national platform, and we will support organisations to adopt the FDP and align their data architecture to it.

We will work across NHS England to ensure that data is easily and readily available to you.

B. NHS IMPACT

NHS IMPACT is our single, shared NHS improvement approach. It is designed to create the right conditions for continuous improvement and high performance and help you to respond to challenges and deliver better care for patients and better outcomes for communities.

We are asking all organisations to commit to implementing an improvement programme this year, using an agreed methodology, if they do not already have one in place.

The NHS IMPACT Clinical and Operational Excellence Programme is a national programme grounded in practical support. It includes improvement guides which are a reference point for what good looks like. We will keep these up to date and incorporate your practical experience on the ground. These guides are supported by enhanced analytics on the Model Health System, providing variation analysis.

Opportunities for providers and systems to come together for peer learning and sharing best practice will be enabled through Learning and Improvement Networks (LINs). While the LINs have a focus on consistently applying best practice to reduce variation, we will also work with some of our best performing systems and providers to design future approaches and models of care through Improvement Collaboratives.

To support this improvement approach we will start to roll out a Board and Executive level development programme to support leading for improvement. We will also deliver at scale a clinical and operational training programme to build skills and capability.

C. Minimising waste, maximising care

Frontline teams have the best insight into the changes and improvements which maximise their resource, minimise waste and make the most difference to patient care. We will be launching a national campaign to support and empower clinicians and frontline staff to generate, implement and share such ideas.

Before the start of the new financial year, we will provide you with campaign materials, tools and examples to implement locally. The materials will help you launch and run local idea generation and testing. We will set up a national platform for the most successful ideas to be shared with others enabling scaling of best practice.

D. Commissioning and transformation

We need effective strategic commissioning to achieve improved health outcomes that maximise value for local populations. This is a key role and responsibility of ICBs.

We will share a new Strategic Commissioning Framework with you covering the role and effective practice at system, place and neighbourhood levels. The Framework will include ways in which providers can deliver strategic commissioning directly (through delegation arrangements and provider collaboratives, for example). We will also work with ICBs to strengthen their commissioning of general practice, dentistry, optometry and community pharmacy.

By this summer, the Framework will be complemented with a development plan, which will detail the functions and skills needed for successful strategic commissioning, so colleagues have the support they need. The development plan will also include co-produced programmes of work which will support ICBs’ strategic commissioning.

Alongside the Framework and Development Plan, in the spring we will provide you with:

  • details of a new Commissioning and Transformation Support Programme for GP commissioners which will support ICBs to create the right conditions for improving general practice, including contractual management and transformation, leading to benefits for patients and the workforce
  • updated guidance on the Provider Selection Regime to provide greater clarity on the different procurement processes that ICBs can use to arrange services, including when awarding integrated neighbourhood health contracts
  • neighbourhood health guidelines for 2025/26 to recognise a neighbourhood health approach, with multi-disciplinary teams at its core, that will play a key role in improving outcomes for and experience of patients. We have published neighbourhood health guidelines for 2025/26 alongside the planning guidance.

E. Leadership and management development

The compacts between systems and NHS England will describe how we will support leaders and managers to deliver the best possible care for our patients. We will continue to invest in developing our leaders and managers, both clinical and non-clinical, giving them access to high quality, time-efficient learning and development alongside a fair and equitable employee value proposition linked to delivery and performance.

A new NHS Management and Leadership Framework will be implemented in 2025/26 comprising:

  • a code of practice for all NHS managers (including values and behaviours), which we will provide you with this spring
  • tools and support to help self-assess against the code
  • professional standards and competencies for all managers and leaders, which we will share with you this summer
  • appraisal proformas and guidance, linking to the code, standards and competencies
  • a national management and leadership development curriculum to inform and enable local delivery of development
  • refreshed national leadership and management development programmes, from entry level to senior manager level, and bite sized learning

In 2025/26, every manager and leader – including at NHS England – will self-assess against the code of practice. Standards and competencies will form part of appraisal processes, with 360-degree feedback, to help with creating personal development plans and support good career conversations. There will also be a new board member appraisal proforma shared with you this spring, aligned to the NHS Board Leadership Competency Framework.

A suite of further support is being put in place. This includes a new online national induction for all new joiners to the NHS; tailored induction programmes for chairs, chief executives and non-executive directors; refreshed Aspiring Chief Executive and Aspiring Director programmes; and a relaunched Aspiring Chair programme.

Our culture and leadership programme helps organisations to understand their own culture using evidence-based tools and to design tailored strategies for developing compassionate, inclusive and collective leadership and deliver culture change.

We are developing an approach to support leaders to work in our most challenged places, which we will share with you in the spring.

F. Supporting our workforce

The People Promise is what thousands of staff said mattered most to them to make the NHS a great place to work. Under its 7 domains sit tangible interventions which some organisations have already implemented with demonstrable impact. The retention hub on our website is a repository with case studies setting out the detail of those practical interventions, delivered through the National Retention Programme. We are asking all organisations to engage with the People Promise and to make it a reality for their staff.

A report will be launched in the coming weeks which will share the data from the 23 organisations in the People Promise Exemplar Cohort 1; this will set out how increased staff satisfaction, productivity and innovation can be achieved in part through the People Promise, together with the return on investment in workforce and fiscal terms.

A range of national health and wellbeing resources are available which complement what is available locally.

The equality, diversity and inclusion improvement plan and the Sexual Safety Charter provide important practical ways we can all protect our staff and ensure they can thrive and perform at their best.

4. Using what we provide nationally to drive improvement and solve common problems

NHS England provides tools, systems, services, programmes and guidance which benefit from being developed and delivered once nationally, shaped using your feedback, rather than duplicated many times across the country. We want to give as many systems as possible greater autonomy and freedom, while applying a single national approach to help solve complex problems.

A. Supporting commercial decisions

To support systems to deliver efficiencies by improving your commercial arrangements, we will:

B. Taking a strategic approach to estates and critical infrastructure

The NHS needs modern and sustainable infrastructure to deliver high-quality and efficient care and our net zero commitment. We will support systems to deliver the infrastructure strategies you produced in 2024/25, and by using ‘core’, ‘flex’ and ‘tail’ categorisation of estate to make ongoing improvements. Our guidance on developing a 10 year infrastructure strategy will support you.

We need reliable data on the condition of the estate so we can mitigate disruption. We will support and advise systems on assessing the impact (time and cost) of disruption to clinical services due to estates failure. We will work with systems on this by the summer. We will be making improvements to the capital business case process and will publish a revised process in the spring.

For all capital projects delivered outside of operational capital, our national capital reporting tool will support you to more accurately profile and forecast funding. To help providers produce Development Control Plans, we will publish the Estate Code in late spring.

We are providing systems with allocations or indicative allocations that cover as many of the capital funding streams available in the year as possible, in parallel with the release of the 2025/26 planning guidance. This includes new funding streams for improving the safety of the acute estate, the utilisation of the primary care estate and for reducing out of area mental health placements. As far as possible, we are joining up the planning process so that systems will set out how they propose to use national programme capital in line with the wider planning timetable, and we will aim to approve spending as soon as possible once plans are agreed. We are also reviewing capital business case processes for opportunities to streamline and accelerate the process.

Our aim is to better enable systems to develop high-quality, integrated capital and revenue plans considering their various requirements and resources in the round. We are also reviewing capital business case processes for opportunities to streamline and accelerate the process.

C. Supporting digital infrastructure for staff and citizens

Digitisation is central to a more productive health system. Highly digitised trusts are more cost efficient.

An extensive array of national services are operated by NHS England which providers are encouraged to connect to and maximise the use of. Information on each service is available on the National Service Catalogue.

We also set out information on the national standards for the recording and communicating of data in the NHS Standards Directory, which all services are encouraged to comply with.

In recognition of the huge role digital will play in delivering our 2025/26 priorities, we will:

  • continue to issue funding to trusts to develop and optimise their Electronic Patient Records, as well as provide additional support for implementation through ‘tiger teams’
  • consult on and publish a target data architecture for the NHS
  • provide the necessary data, interoperability infrastructure, guidance and onboarding support for national products, including the Booking and Referral Standard, the Electronic Prescription Tracker and the NHS e-Referral Service
  • provide a list of assured social care record systems
  • assist trusts to plan and carry out their move to the national NHS.net Connect Service to drive improvements for staff and save money
  • provide additional advice, guidance and technical assistance to enhance cyber security in line with the 2030 cyber security strategy
  • continue to develop the NHS Marketplace, our platform for sharing digital innovations across the system

There are extensive opportunities available to deliver benefits from existing national technology services where they are not fully deployed across the NHS estate, or where they are not yet fully embedded or where there is duplication with legacy services. We will support ICBs to make best use of technology already available nationally and extend its coverage to all parts of their system.  

A digital-first approach can save around £350 million annually on patient communications, mainly from paper letters. Across the NHS, a switch to NHS App based notifications reduces administrative and clinical burdens, print and SMS costs, calls to clinical teams, and on-day cancellations. Patient Engagement Portals and other technology enable patients to manage and cancel appointments on the NHS App, significantly reducing the number of missed elective care appointments.

To enable these benefits NHS England will:

  • continue to develop the NHS Notify service and to support providers to connect to it
  • support trusts to implement and optimise Patient Engagement Portals or integrations into the NHS App
  • provide technical and clinical guidance to trusts on connecting their secondary care referrals and booking systems and the national personal demographics service to the NHS App, enabling NHS App messages to be sent to patients in bulk or individually. Our guidance will include message and letter templates, clinical questionnaires and how to reach recipients with access or language needs
  • enhance national products to support frontline staff and increase the ability for patients to self-manage their medicines
  • develop new features to improve read and response rates for messages sent via the NHS App

D. Tools and resources to help you reduce healthcare inequalities 

To support regions, ICBs and providers to deliver the health inequalities improvements set out in the planning guidance, here is a summary of our resources:

5. Please provide feedback on our approach

What we have described above are the first steps to implement our new operating model with you. By implementing it consistently, we want to make sure you get the support you need, when you need it. Please let us know if you have any feedback on what we have set out and if you have any suggestions, by emailing england.systemarchitecture@nhs.net

Publication reference: PRN01826

Date published: 30 January, 2025
Date last updated: 30 January, 2025