The NHS medium-term framework: stability, productivity and the digital mandate

NHS England has for the first time, published its Medium-Term Planning Framework (MTPF) for 2026/27 to 2028/29. This is not another short-term policy document. It’s a welcome move away from annual planning cycles.

For pharma, medtech, and NHS leaders, this framework provides a three-year line of sight. It sets out the financial terms, operational priorities, and strategic direction the health service must take. Understanding its implications is essential for planning and partnership.

Why the guidance matters

The MTPF’s primary function is to create stability. By moving to a multi-year framework, NHS England provides Integrated Care Systems (ICSs) and provider trusts with the headroom to plan beyond the immediate financial year.

This stability is welcome, but it comes with expectations. The framework is the implementation plan for existing national strategies, including the 10-Year Health Plan and the Life Sciences Sector Plan.

• For the NHS: This is a reset of the operating model. It empowers local leaders but holds them accountable for delivering ambitious targets on elective recovery, cancer, and urgent care. Financial discipline is absolute, with a mandated 2% productivity gain and a requirement for all systems to reach a break-even position.
• For pharma and medtech: The framework defines the NHS market for the next three years. It signposts exactly where resources and focus will be directed. Success will depend on aligning solutions to three core strategic shifts: moving care from hospitals to neighbourhoods, driving prevention, and enforcing a 'digital-by-default' ecosystem.

Meaningful impacts for pharma and medtech

Beyond the headline recovery targets, the framework contains specific, impactful initiatives for industry.

For medtech and digital health

The push for digital is no longer just an ambition; it is a core operational mandate. The plan accelerates the adoption of specific technologies to manage demand and improve productivity.

• The NHS App as the "front door": The goal is for the app, supported by AI-assisted triage, to become the single point of access for patients.
• Data integration: Mandated adoption of the Federated Data Platform (FDP) will underpin planning and research.
• New technology adoption: The guidance explicitly names priorities like Ambient Voice Technology (AVT) to reduce clinical admin and digital therapeutics for direct care delivery.
• Clearer market access: The framework supports the Life Sciences Sector Plan’s "Rules Based Pathway" and "Innovator Passport," designed to speed up adoption of proven medtech.

For pharmaceuticals

The framework's focus on efficiency, pathway standardisation, and prevention creates direct challenges and opportunities.

• Single National Formulary: This is a significant development. The plan commits to introducing a Single National Formulary by the end of 2027. This will start by targeting high-spend areas, specifically Direct Acting Oral Anticoagulants (DOACs), SGLT-2 inhibitors, and pathways for wet AMD.
• Modern Service Frameworks (MSFs): The NHS will develop new MSFs to define evidence-based, digital-first care pathways. The first areas will be cardiovascular disease, serious mental illness, and sepsis, followed by dementia and frailty. Pharma will need to ensure its associated products and data support these national standards.
• Prevention and community: The shift to neighbourhood care and population health management moves the focus from acute treatment to long-term condition management and prevention, opening opportunities for solutions that keep patients out of hospital.

Any surprises in the guidance?

No big surprises as the MTPF is an exercise in execution, rather than a new strategic direction. It takes existing policies established in the ‘Fit for the future’ 10-year plan and attaches firm targets, financial levers, and timelines to them. It takes existing policies established in the ‘Fit for the future’ 10-year plan and attaches firm targets, financial levers, and timelines to them.

However, there are points of tension. The NHS Confederation highlights potential "mixed messages" in the framework’s desire to devolve power to local systems while simultaneously being highly prescriptive on national targets.

For some, the plan also has "striking omissions." The Centre for Mental Health, for example, notes that despite being a priority, the framework lacks new funding commitments or access standards for mental health services, falling short of the ambition needed.

How pharma and medtech must work with the NHS

The MTPF solidifies the trends of recent years. Future partnerships between industry and the NHS must be built on a new understanding of NHS priorities.

1. Productivity is the price of entry: The 2% productivity target is not negotiable. Any new product, device, or service must have a clear, evidence-based case for delivering efficiency, releasing clinical time, or reducing system costs.
2. Digital integration is mandatory: Solutions must fit within the new NHS digital architecture. For medtech, this means interoperability with the NHS App where relevant, Electronic Patient Records (EPRs), and the FDP. For pharma, this means embracing digital therapeutics and data-driven pathway improvement.
3. The focus is local: While national frameworks are being set, delivery is the responsibility of ICSs and neighbourhood teams. Industry must engage at this level, understanding local population health needs and demonstrating how its solutions help ICS and other local leaders meet their specific financial and operational targets.
4. Align with the new pathways: The new Single National Formulary and Modern Service Frameworks will standardise care. Industry must generate evidence that supports inclusion in these pathways and aligns with the goals of prevention and community-based care.

Expert summary

The 2026/27 Medium-Term Planning Framework provides the NHS with a welcome, if challenging, period of stability. It ends short-term planning and focuses the entire system on three goals: elective recovery, financial balance, and productivity.

For the pharmaceutical and medtech industries, the demand is for technology that is integrated by default, not as an add-on. The value proposition must focus on efficiency. And the partnership model must shift to support ICSs and neighbourhood teams in managing population health and moving care out of the hospital. The introduction of a Single National Formulary and new Modern Service Frameworks will be defining developments for the pharmaceutical market over this period. This strategic direction will soon be followed by financial detail; Sir Jim Mackey confirmed at the recent King's Fund conference that the associated funding rule changes for the next three years are expected to be published later this month.

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