The publication of the NHS Medium Term Planning Framework (MTPF) 2026/27 to 2028/29 marks a fundamental strategic and psychological shift for the health service.
At its core, the framework is the comprehensive national planning guidance for the next three years, superseding the pattern of short-term, reactive annual operating plans. This multi-year horizon is not merely a procedural change; it is a deliberate intervention designed to provide stability and headroom for local leaders, who for years have been, in the words of NHS England’s chief executive, “stuck in a doom loop” of not being able to plan beyond the immediate financial year (something we discussed in our blog, The Quiet Revolution in The 10-Year Plan).
Where the NHS 10-Year Plan was the “what,” this framework is the “how.” Or, to put it more accurately, this framework is the beginning of the “how”. As we will see, there are still some pretty big questions left unanswered by the NHS Medium Term Planning Framework.
For the next three years, the framework sets out to create stability by replacing process bureaucracy with rigid outcome accountability. For primary care leaders, it demands a move from firefighting to long-term strategic implementation. Let’s take a look at some of these key immediate priorities laid out in the plan and where primary care leaders still need some clarification.
The Key Strategic Shifts
The Medium Term Planning Framework consolidates all expectations to deliver the three core shifts we’ve discussed before:
- Hospital to Community: Moving investment and focus to neighbourhood care.
- Analogue to Digital: A “digital-by-default” ecosystem.
- Sickness to Prevention: A reorientation to proactively managing population health.
These ambitions are now backed by hard targets and non-negotiable mandates. Here are some of the key targets set out for primary care:
| Service Area | Key Metric | Target | Timeline |
| Primary Care | Clinically urgent patients seen same-day | 90% | 2026/27 – 2028/29 |
| Primary Care | Patient experience of access (ONS) | Year-on-year improvement | 2026/27 – 2028/29 |
| Pharmacy | Maximise Pharmacy First | Maximise uptake | 2026/27 – 2028/29 |
| Pharmacy | Roll out new services (e.g., EC, HPV vax) | Full rollout | 2026/27 – 2028/29 |
Immediate Priorities for Primary Care Leaders
Prepare for the 90% Access Target
The Medium Term Planning Framework introduces a new “ambition” for 90% of “clinically urgent” patients to be seen on the same day. As the RCGP has noted, this is a huge challenge that will require a fundamental redesign of triage and access models. The framework states this will be “subject to consultation,” which is likely to be a “tense” process, given the workforce implications.
Implement the Digital Mandate
This is not optional. The framework sets hard targets, including making 95% of appointments (post-triage) available for booking via the NHS App. It also mandates the deployment of ambient voice technology (AI-powered scribes) to reduce the administrative load on clinicians.
Action the ‘Neighbourhood Health’ Model
This is the key strategic action for PCNs. The plan requires ICBs to map care utilisation for frail cohorts and develop plans to shift resources from hospitals to community provision. This is the new mechanism for delivering proactive, integrated care and supporting high-priority groups like care home residents.
Prepare for the Financial ‘Squeeze’
The Framework signals a clear end to the era of bailouts. Leaders must plan for a hard 2% productivity gain year-on-year, with deficit support being removed from 2026. This strict financial discipline is the non-negotiable backdrop for all other decisions.
Critics, Gaps & Unanswered Questions
The reaction from many professional bodies and health policy experts (particularly to the 90% target) has been mainly scepticism and concern. While NHSE have promised consultation with the NHS on these targets and how they are implemented, critics of the plan argue that such a fundamental philosophical shift needs additional clarity in some key areas:
The Productivity & Funding Gap
The entire plan requires 2% productivity growth, but the long-term NHS average is 0.9%-1%. As the Health Foundation highlights, this creates a potential £13bn funding gap by 2028/29. This is a high-stakes gamble for the entire system.
The Leadership Gap
The Framework introduces a paradox for primary care leaders to deal with. On one hand, it imposes the rigid, target-driven accountability detailed above. On the other hand, it explicitly attempts to redefine good leadership as “much more than hitting targets,” by engaging with 360 feedback. It’s not an impossible balance, but it’s a balance that requires skill, nuance and something that will likely take some honing.
The Definition Gap
The framework’s flagship GP target hinges on the term “clinically urgent,” which is left completely undefined. This ambiguity creates a “risk of perverse effects—including hitting the target but missing the point,” as the BMJ notes, and puts PCN leaders in a difficult position of having to define it themselves.
The Strategic Pharmacy Gap
This is the framework’s most critical workforce oversight. The MTPF focuses transactionally on community pharmacy tasks (like Pharmacy First and contraception). It completely ignores the strategic opportunity of the new wave of pharmacist independent prescribers graduating from 2026.
As the Pharmaceutical Journal points out, this new workforce is the perfect solution to help manage the very chronic disease and access targets the MTPF is imposing on primary care, which is a disconnect that local leaders must now solve.
“The framework creates a central conflict for primary care leaders: it demands they solve a massive access and productivity crisis (while simultaneously failing to leverage some clear workforce solutions – integrating pharmacist prescribers, for example) and adds a new layer of challenges to overcome.”
What comes next?
The Medium Term Planning Framework provides a clear (if challenging) direction. As The King’s Fund notes, it’s a “narrow path” that balances welcome stability with immense performance pressure.
The framework creates a central conflict for primary care leaders: it demands they solve a massive access and productivity crisis (while simultaneously failing to leverage some clear workforce solutions – integrating pharmacist prescribers, for example) and adds a new layer of challenges to overcome. Further Frameworks (including the model Neighbourhood Health Guidance) expected before the end of the year could help shine some more light on some of these concerns.
While the Medium Term Planning Framework may not provide the full answer, the solution to its demands lies in strategic workforce design. PCNs that proactively and intelligently embed clinical pharmacy teams to manage chronic conditions, polypharmacy, and acute demand will be the ones who can meet the framework’s targets and build a sustainable practice for the future.
Navigating this new framework requires a robust workforce strategy. Contact Medacy to find out how our managed clinical pharmacist services can help your PCN meet the challenges head-on.
