The Medium Term Planning Framework (MTPF) is NHS England's planning guidance for 2026/27 to 2028/29, published in October 2025. It replaced annual planning guidance with a three-year framework setting the financial rules and performance targets that Integrated Care Boards and NHS Trusts must meet while delivering the 10 Year Health Plan.
The framework moves the NHS from annual to medium-term planning. Integrated Care Boards (ICBs) and providers submit five-year strategic plans and three-year numerical returns, backed by three-year revenue and four-year capital allocations from the 2025 Spending Review. NHS revenue rises by 3% in real terms to £226bn in 2028/29. In return, every ICB and provider must be in balance or surplus each year, improve productivity by at least 2% a year, and break even without deficit support by the end of the period.
The MTPF turns the 10 Year Health Plan into dated commitments that affect industry directly. It confirms a Single National Formulary within two years, with early savings sought from best-value direct oral anticoagulants, SGLT-2 inhibitors and the wet age-related macular degeneration pathway. It names the first Modern Service Frameworks (cardiovascular disease, serious mental illness and sepsis, followed by dementia and frailty), requires all acute, community and mental health providers to use the Federated Data Platform by 2028/29, and asks providers to deploy ambient voice technology. With a productivity target written into every plan, new products and services need a clear case for releasing staff time or reducing cost.
The framework refers to the proposed abolition of NHS England. The Health Bill, which would merge NHS England into the Department of Health and Social Care by March 2027, was at committee stage in the House of Lords in October 2026 and is subject to parliamentary approval.
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