NHS England’s 2025/26 planning guidance sets out the operational priorities for the year ahead, with a strong focus on reducing waiting times, improving access, and increasing efficiency. But beyond the headline commitments, the financial reality tells a different story. 

While the budget  promised a 4% funding uplift, rising costs higher employer national insurance contributions, increased staff pay settlements, the impact of high-cost treatments, and relentless demand growth will quickly absorb it. Once these pressures are accounted for, many in the sector will feel that budgets are effectively shrinking rather than growing. At the same time, NHS England is requiring a 4% improvement in productivity, a difficult target given historical productivity growth has been less than 1% per year. 

For primary care, the impact will depend on how ICBs choose to allocate resources and prioritise services. Here are five key takeaways from the guidance – and what they mean for general practice, PCNs, and digital transformation. 

1. A Tough Financial Reality: Doing More With Less 

The NHS is facing one of its most financially constrained years yet. The headline 4% budget increase is largely offset by rising employer costs (such as pay settlements and national insurance), meaning many in the sector see this as closer to a 2% real-terms uplift. Meanwhile, demand continues to rise—putting even more pressure on services. 

To bridge the gap, systems are expected to deliver 4% efficiency savings, almost twice last year’s target and four times the NHS’s historical productivity growth rate. In practical terms, this means: 

• ICBs and providers must prioritise cost-cutting—which could see some services reduced or restructured. 
• More reliance on digital transformation and workforce optimisation to absorb growing demand without additional resources. 
• Greater scrutiny of primary care spending, with a risk that investment leans more towards NHS Trusts and hospital-based services. 

For primary care, this reinforces the need to demonstrate impact and value, ensuring that GP practices and PCNs are central to local system planning—not just an afterthought in wider cost-cutting exercises. 

2. More Power to ICBs—But What About Primary Care?

ICBs are being given more autonomy over funding and decision-making, with NHS England stepping back into more of an oversight role. This means less ring-fencing of budgets and more local flexibility—but also greater responsibility for balancing the books. 

For general practice, this shift could go one of two ways: 

• Best-case scenario: ICBs use their greater flexibility to invest in primary care, strengthening neighbourhood models and supporting digital transformation. 
• Worst-case scenario: Resources continue to flow towards more expensive NHS Trust and acute services, leaving primary care with less influence and funding. 

The balance of power is shifting. Whether this benefits general practice and PCNs will depend on how well primary care leaders engage with their local ICBs and leadership teams from other providers. 

3. Primary Care Access & Digital Integration Stay in Focus

Improving patient access remains a core priority—particularly for general practice and urgent dental care. However, while there are clear numerical targets for urgent dental care and elective appointments, the objectives for general practice are less defined. This could be linked to ongoing GP contract negotiations, meaning there’s some uncertainty around how access improvements will be measured or incentivised. The key commitments include: 

• Increasing urgent dental appointments by 700,000. 
• Improving patient access to general practice, measured through patient experience data.  The reliance on the ONS Health Insights Survey may be a concern for Primary Care, as this national panel survey provides a broad overview but lacks the granular detail that ICBs need to assess local access challenges effectively. 
• Expanding NHS App functionality, with 70% of elective care appointments accessible online. 

There’s also a continued push for digital transformation, with expectations that: 

• More patient interactions will be handled online. 
• GP practices will offer more digital access to records, prescriptions, and appointment bookings. 
• The NHS Federated Data Platform (FDP) will drive efficiencies in elective care. 
• Addressing digital exclusion is crucial in the planning guidance to ensure that everyone desiring to use digital services has the opportunity to do so. 

For PCNs and practices, this means continued investment in digital-first pathways, automation, and more structured use of online consultations and messaging tools. The challenge will be ensuring these tools reduce pressure on staff, rather than creating additional workload and complexity. 

4. Neighbourhood Health Services: More Than Just a Concept?

The NHS is doubling down on integrated neighbourhood care—a long-standing ambition to shift focus from hospitals to community-based prevention. The guidance highlights: 

• Expanding multidisciplinary teams (MDTs) at a neighbourhood level. 
• Better integration between general practice, community services, and pharmacy. 
• A push for primary care to take on more responsibility for preventing unnecessary hospital admissions. 

This aligns with the broader move towards local autonomy—but again, funding is the question. Will ICBs properly resource neighbourhood teams, or will this be another unfunded aspiration? 

For PCNs, this reinforces the need to scale up local collaboration efforts and push for clear investment plans at an ICB level. 

5. Workforce & Efficiency Pressures Will Intensify

The workforce crisis isn’t going away, and this year’s plan makes it clear that: 

• ICBs and providers must reduce spending on temporary staffing. 
• Bank and agency use should be cut by at least 30%. 
• More focus is needed on staff retention and productivity. 

In practice, this means more pressure to optimise GP workloads, reduce administrative burden, and make better use of support roles, digital triage, and remote consultations. 

At Redmoor, we’ve already seen how digital solutions can reduce workload pressure when properly implemented. Practices that get ahead of the curve on automation, digital triage, and patient communication will be best placed to manage rising demand without overstretching staff. 

What This Means for Primary Care & How Redmoor Can Help 

At Redmoor Health, we are already working with practices, PCNs, and ICBs to help navigate these changes. Whether it’s improving digital access, streamlining patient communication, or supporting workforce efficiency, our expertise ensures primary care remains at the centre of system-wide transformation. 

Final Thoughts 

The 2025/26 NHS Planning Guidance reflects a system under pressure—focusing on recovery, financial sustainability, and local autonomy. 

For primary care, the biggest challenges will be:
✔ Advocating the prioritisation of general practice, over hospital-based services by ICBS.
✔ Making digital transformation work without creating additional workload.
✔ Navigating workforce and efficiency pressures while maintaining high-quality patient care. 

There are opportunities in neighbourhood health services and digital innovation, but these need real investment and commitment—not just targets on paper. The next year will test whether local systems can truly deliver on these ambitions. 

At Redmoor, we are ready to support practices through these challenges—helping to turn strategy into practical, impactful change.