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Medium Term Planning Framework: what you need to know

Summary and analysis of the Medium Term Planning Framework, published on 24 October 2025.

  • Finance

  • Delivery and performance

Download the briefing $Medium Term Planning Framework What You Need To Know (1) 411.0 kB

Key points

  • The Medium Term Planning Framework sets out performance targets and requirements for NHS organisations over the next three and five years, unlike previous annual planning rounds. Integrated care boards (ICBs) and providers must develop robust and realistic three- and five-year plans to deliver these priorities.
  • The framework sets out next steps to deliver on the 10 Year Health Plan for England and aims to move away from short-term planning to a system that empowers local leaders to plan over the medium-to-long term, and which supports innovation to deliver long-term sustainability. 
  • The framework helps to bridge the gap between immediate pressure for recovery with deeper, but longer-term, reform. It does offer a path to recovery, but it is a narrow one with several big risks to navigate along the way, including a precarious financial position and potential unfunded costs to come alongside the need for additional private capital to be decided upon at the Budget in November 2025. 
  • Alongside the framework, NHS England will publish at least 20 additional guidance and resource documents for ICBs and providers over the coming months (see appendix), for areas from neighbourhood health to integrated health organisations, setting significant central direction. 
  • With 15 headline success measures over a three year-period, down from 18 in the 2025/26 Planning Guidance and 133 in 2022/23, the framework continues the recent trend of providing local leaders with greater focus to better enable delivery. However, it includes many more requirements, albeit over a longer three-year period.
  • Coming five months before the next financial year, it also provides more time for local leaders to build its expectations into realistic plans. However, with much information still to come in and so many pieces of further guidance promised, the framework only goes so far to inform planning.