Below, we provide advice on how members can engage with this issue locally, as well as an overview of the plans, targets, and policies the UK Government and NHS England hope will deliver elective recovery.
Background: waiting lists, elective recovery and reform
Waiting lists in England remain enormous and the NHS continues to fall well short of its target for 92% of patients to wait 18 weeks or less from referral to treatment.
Although waiting lists are currently lower than their September 2023 peak, they remain drastically higher than prior to the pandemic and progress towards reducing them has, to date, been slow. For more information on waiting list statistics and elective performance, see the BMA’s dedicated analysis on our Pressures Hub.
Because of this, and in line with its election promises, the Labour Government has centred its health policies on the reduction of both waiting lists and, in particular, waiting times.
New plans, new targets, and new policies for elective recovery
Labour’s principal health policy is for the NHS to meet the 18-week target by 2029, the end of this Parliament.
With a view to hitting this overarching target, a new elective reform plan - Reforming elective care for patients – has been launched with the aim of changing the way elective care is planned, delivered, and paid for.
This plan ultimately relies on both secondary care and general practice doing more and includes a major focus on making greater use of the private sector.
Local approaches to tackling waiting lists have also been favoured by DHSC, including negotiating rates of overtime pay for doctors. While the plan supports and seeks to build on local innovation, it provides a much-needed national framework alongside tools and resources to enable success.
NHS England’s 2025/26 planning guidance operationalises the plan and sets out interim targets for elective performance, focused on increasing activity and productivity.
This approach to elective recovery and its associated reforms and targets could have significant implications for the daily working lives of doctors. Therefore, the details of the plan and advice on how members can engage with it are set out below.
What we are calling for
The BMA is calling on the UK Government to:
- negotiate with the BMA on national minimum rates of pay for additional elective work
- resolve pension and taxation disincentives that prevent some doctors from undertaking additional hours
- invest in and support for GP practices to care for patients awaiting treatment
- properly value doctors to retain them and invest in growing the medical workforce to meet the scale of the challenge
- ensure transparency and value for money of ISP contracts
- increase capital funding for maintenance and new facilities and that funding is directed to where it is most needed.
The BMA views the creation of this plan and its ambition as a welcome sign that ministers are serious about addressing the challenges facing the health service, but there are significant omissions from it that we believe need to be resolved.
We believe that without serious action to properly value, retain and expand the NHS workforce, efforts to tackle waiting lists will not make the progress we so badly need. New technologies and a reliance on the now largely depleted goodwill of staff will not be enough to deliver the reform and progress towards achieving the 18-week target.
The NHS needs to invest in hospitals and general practice to enable patients to get the right care in the right place. More must also be done to reduce bureaucracy that diverts valuable clinical time away from patient care, alongside wider action to promote more seamless working between clinicians across sectors.
Related
The BMA’s response to the NHS 10-Year Plan consultation
What you can do
LNC representatives
- Communicate the BMA’s guidance and response to the plan to medical staff in your trust.
- Work to raise member expectations of what rates for additional work are fair and in line with the best rates achieved elsewhere, seeking advice from other LNCs.
- Discuss with Trust management how they intend to meet NHSE’s targets and ensure these plans are realistic and protect doctors from burnout.
- Ensure employers enter into negotiations, where ICBs and other groups of employers collaborate on arrangements for securing extra contractual work.
- Ensure there are adequate facilities in the workplace to allow doctors to rest and work effectively.
Hospital doctors
- Ensure any additional work is captured in job plans.
- Manage safe working patterns and avoid burnout.
- Immediately raise a concern if you are feeling pressured or bullied into working additional hours or taking on additional unpaid work.
- Make use of exception reporting (resident doctors) when there is any variation from the planned working hours or training opportunities in your work schedule.
Related
BMA Consultants Charter
BMA SAS Charter
BMA Fatigue and Facilities Charter
GPs
- Continue to monitor the use of A&G (Advice and Guidance) and ensure that any associated workload is manageable and appropriate, regardless of the available fee.
- Via local LMCs, engage with ICBs on the introduction and implementation of the proposed standardised referral criteria.
- Report to LMCs on the level of work associated with supporting patients awaiting elective care, to support local and national lobbying.
Related
Safe working in general practice in England (guidance)
Patients First: GPCE’s vision for general practice
Sessional GP: A vision for the future
Working across the primary-secondary care interface
- Elective care and plans for its recovery apply to the whole system and members across all branches of practice will need to coordinate and communicate to ensure the best outcomes for all.
- LNCs and LMCs should collaborate locally, including via Regional Councils.
- Branch of practice committees should renew their collaborative work on the interface, with an emphasis on elective recovery.
Private practice (private provision of NHS-funded care)
- Ensure you are adequately paid for this work in line with the BMA’s minimum suggested rates.
- Ringfence time spent on privately provided NHS work.
- Ensure private providers explicitly cover your medical indemnity for any work you undertake.
Public health
- Seek to engage with your local ICBs, especially on their work regarding waiting list initiatives and disparities.
- Lobby your local ICB on the critical importance of an independent, qualified public health specialist voice on their board.
Overview of the plan
The plan aims for the NHS to achieve the 18-week performance standard by March 2029.
As a first milestone, the plan commits to 65% of patients being seen within the 18-week standard by March 2026, with every trust expected to deliver a minimum of a five percentage point improvement against the target in the same timeframe.
As set out in its 2025/26 planning guidance, NHS England also wants:
- 72% of patients to wait no longer than 18 weeks for a first appointment by March 2026
- less than 1% of the total waiting list to wait over 52 weeks for treatment by March 2026.
DHSC and NHS England propose achieving this by focusing on four particular areas:
- empowering patients
- reforming delivery
- delivering care in the right place
- aligning funding, performance oversight, and delivery standards.
The plans for each of these areas are examined below – alongside brief BMA analysis.
Empowering patients
The plan includes measures to give patients greater control over their care, including when, where, and by whom it is delivered. It also sets out changes intended to make the experience of planned care more convenient.
View specific policies in this section:
- Publication of minimum standards that patients can expect to experience in elective care.
- Further promotion of patients’ right to choose, including ensuring patients can view factors like distance, waiting time, and CQC rating to inform their choice of provider – in the NHS or independent sector.
- Providers making customer care training available for non-clinical but patient-facing staff.
Expansion of the NHS App and Manage Your Referral website, including:
- making the NHS App the default route for patients choosing elective providers
- all providers enabling 85% of patients to access appointment information via the NHS App by the end of March 2025
- reviewing the role of My Planned Care, which currently lets patients see average waiting times for providers.
- ICBs (Integrated Care Boards) establishing local approaches to reducing health inequalities and disparities in healthcare access as part of elective reform.
- Areas with greater health inequalities being prioritised for future investment in capacity and reviewing existing national health inequalities improvement initiatives.
BMA Analysis
Greater access to information for patients – as well as efforts to improve their experience of care – are welcome, particularly for those experiencing long waits for care. Existing systems, like My Planned Care, have had limited functionality and provided very little information to patients.
However, care must be taken to account for digital exclusion and the fact that some patients may struggle to access online tools or to effectively engage with services via the NHS App. It is critical that mitigations are put in place to ensure these patients are not left behind and that digital exclusion is not exacerbated.
The focus on health inequalities within the plan is also important and addresses a failure to incorporate this issue into previous efforts to bring down waiting lists, such as the 2022 Delivery plan for tackling the COVID-19 backlog of elective care.
It is essential that, as the BMA has consistently called for, ICBs all have a dedicated board place for an independent, qualified public health specialist, to ensure that they have the insight and expertise they need to understand and address health inequalities. This role would also be crucial in targeting resources, utilising data effectively, and helping to mitigate potential risks such as digital exclusion.
Reforming delivery
The plan sets out a series of reforms intended to improve the productivity and consistency of elective care delivery, including changes to where and how some care is delivered.
See what this includes:
- Launch 17 new and expanded surgical hubs by June 2025.
- Extend the opening hours of CDCs (Community Diagnostic Centres) to 12 hours per day, seven days a week by March 2026.
- Expand the capacity of CDCs to deliver same-day services, a wider range of tests, and 10 ‘straight-to-test’ pathways – with providers and ICBs expected to increase direct referrals to CDCs.
- Invest in up to 13 new DEXA (bone density scanning) scanners, focused on high priority locations, to improve early diagnosis and bone health.
- Standardisation of remote consultations and remote monitoring of conditions.
- Use of AI and digital tools to improve productivity in surgical centres.
- Adoption of PIFU (Patient Initiated Follow-up – where patients decide whether they need further appointments based on how they feel) across all major specialities – with the aim of avoiding unwanted appointments.
- Publish (in January 2025) a new ‘Partnership Agreement’ with the independent sector, setting out how the NHS and ISPs (Independent Service Providers) will collaborate to reduce waiting lists.
- ICBs are also expected to ensure they have contracts in place with the private sector to help mitigate system-level waiting list challenges.
- Increase the funding available to support ISP delivery of NHS-funded care in challenged specialities, like gynaecology and ENT.
- Review NHS prices (tariffs) for ISPs where they are perceived to be able to significantly help reduce NHS waiting lists.
- Work with ISPs to review exclusion criteria, to allow for a wider range of patients to be treated by them.
- Deliver plans with national and local professional NHS trainee programmes to provide training within ISPs, where appropriate.
- Strengthen perioperative care to increase productivity, with a focus on smoking cessation and weight management programmes helping to reduce cancellations by ensuring patients are ready for treatment.
BMA Analysis
The further development of CDCs and surgical hubs will play an important role in increasing capacity, but the expansion of both will only be successful in the long-term if sufficient staff are available to run them. The Royal College of Radiologists has recently raised concerns around recruitment freezes in imaging and cancer departments that emphasise this point. Similarly, with introduction of new CDCs and surgical hubs, NHS England must also protect the education and training of students and doctors who work in them.
The BMA will also be closely monitoring the planned expansion of CDC opening hours and its potential impact on doctors working within the centres. Anyone potentially affected by these changes should liaise with their local representatives, especially if any changes might mean that travel and working hours become unsafe.
We will be examining the proposed roll out of AI within the NHS against our principles for its application. The groundwork must be laid to ensure that the NHS has the requisite digital foundation in place to support the deployment of AI-based technologies.
The expansion of PIFU appointments will also need to be monitored closely, particularly to ensure that patients are making follow-up appointments when necessary and that its use is carefully managed.
The emphasis on the use of ISPs and the creation of a ‘Partnership Agreement’ with the private sector is concerning and we will be closely monitoring this agreement when it is published. The final agreement must be clear about the terms of this arrangement, what care it will cover, how long it will last, and the amount of public money that it will involve. The BMA has acknowledged the need to use all available capacity to bring down waiting lists, including capacity within the private sector, but we are clear that priority should always be given to long-term investment in NHS capacity, and that any agreement with ISPs should be short-term, fully transparent, and deliver value for money.
The BMA will also actively support doctors in dispute or undertaking campaigns regarding terms and conditions for staff delivering privately provided, NHS-funded care. This is particularly the case for any doctors working in hospitals where insourcing arrangements – where private providers use NHS elective care facilities on evenings and weekends – are in operation.
The BMA has repeatedly stressed that ISPs and the NHS often share much of the same workforce – so further use of ISPs may lead to further burnout or fail to provide the intended additional capacity. One means of mitigating this would be to ensure doctors involved in this activity are properly remunerated for their extra work.
The BMA broadly supports the extension of training into ISPs – particularly where those ISPs perform a significant number of certain procedures, such as cataracts - to ensure that doctors working in the NHS do not continue to miss out on essential training opportunities.
Care in the right place
In line with the Government’s desired ‘shift’ of care from hospitals into the community, this element of the plan sets out measures that will change where – and by what sector of the NHS – some patients will be treated.
Reforms outlined here include:
- Expand the use of A&G (Advice and Guidance), including via incentivising GPs with a £20 payment per A&G request – this is expected to divert as many as two million potential new cases away from elective care.
- Implement all requirements established by the Delivery plan for recovering access to primary care.
- Standardise pathway referral criteria and implement standard operating procedures for high-volume specialities.
- Establish model ‘collective care’ approaches including group appointments, ‘one-stop’ clinics – with same day assessment and diagnosis or treatment, and ‘super clinics’ – where a wider range of clinicians see patients while being overseen by an accountable consultant.
- Deliver significant reform in five specialities – ENT, gastroenterology, respiratory, urology, and cardiology – to deliver more care in the community.
- Offer PIFU as standard in all appropriate pathways by March 2026 and increase its uptake to at least 5% of all outpatient appointments by March 2029 – supported by the use of AI and automation to identify suitable patients.
- Improve the availability and quality of FDP (Federated Data Platform) products – with adoption of the FDP by 85% of secondary care trusts by March 2026.
- NHS e-RS (e-Referral Service) will be further developed and improved to support joint clinical decision-making and primary-secondary care information sharing.
- Use AI to predict who will miss appointments, automate patient scheduling and test requesting, and to streamline administrative tasks.
- Ensuring waiting list validation – confirming the accuracy of waiting lists and whether patients wish to remain on them – is reflected in the 2025/26 NHS Payment Scheme.
BMA Analysis
The use of A&G has been a significant concern for GPs in England and has been subject to the collective action currently being taken by GPs. However, the plan to fund GPs to use A&G could be an initial positive step towards addressing this particular concern, but further details are needed.
Standardising pathway and referral criteria could help to limit some of the more significant post-code lotteries experienced by patients – but this will need to be kept under review.
If the use of PIFU is expanded as planned, it is important to emphasise that doctors can and should always be able to require scheduled, proactive, or compulsory follow up where they believe it is necessary for a patient. Steps must also be taken to ensure that patients who may be less likely to seek follow up – even if it is needed – are not left behind.
The BMA has long-standing and serious concerns regarding the FDP programme, particularly given its involvement with the company Palantir, and the impact their involvement could have on patient confidence in how their data is handled. Therefore, we are highly sceptical about the significant rollout of FDP products and will be monitoring this situation closely.
Aligning finance, performance oversight, and delivery standards
The plan establishes a range of changes, including to financial incentives and provider oversight, that are intended to support the delivery of the wider plan and to generate increased elective activity.
These changes include:
- Update the NHS Payment Scheme and test new tariffs that might help to reduce patient waits.
- Introduce best practice tariffs to encourage a shift in activity from day case to outpatient settings for six (unspecified) procedures.
- Throughout 2025/26, identify a further 30 areas of clinical activity where best practice tariffs can be tested.
- Increase tariff rates for specific specialties with long waits to increase activity, including within the private sector.
- Run a capital incentive scheme to reward providers that improve the most against waiting lists.
- Train at least 8000 clinical and operational leaders in effective elective pathway management by March 2026, as part of a wider Clinical and Operational Excellence Programme that will help apply proven improvement approaches.
- Run an elective performance oversight programme, tiering providers in line with NHS Oversight and Assessment Framework and enhancing transparency.
- Set expectations for outpatient activity as part of job planning within providers, clearly establishing the types and balance of activities clinicians should undertake, including sessions within the community.
- To support transparency, NHS England will publish a suite of elective performance metrics in an accessible format that can be used by staff and the public.
BMA Analysis
A more flexible and tactical approach to tariffs could have a positive impact on efforts to bring waiting lists down, particularly for treatments that may have been overlooked under previous elective recovery strategies in favour of procedures with lower costs. However, changes to tariffs must be managed carefully to avoid perverse incentives and, particularly where applicable to ISPs, ensure proper value for money.
The BMA has been consistently sceptical of financial incentive programmes, particularly for capital funding, on the basis that they can create perverse incentives and risk trusts with lower activity levels falling further behind. A model that allocates capital funding based on need is preferable and would support the goal of equitable elective recovery the plan sets out.
Regarding the inclusion of expected outpatient activity in job planning, the BMA continues to emphasise that consultants and SAS doctors should have appropriate, collaborative and mutually agreed annual job plans that reflect the entirety of a clinician's role, and that expectations in one specific area – for example, outpatient activity – should not override other aspects of an individual's job plan.
Get in touch
Please contact [email protected] for further information or with any questions regarding this guidance.