NHS Medium Term Plan Radical Reset – How It Plays out in Consultant Interviews

The NHS has published a three-year planning framework that aims to end short-termism and put delivery and reform on the same track. Panels will expect you to do more than quote targets. They will test whether you understand what is changing, why it matters for patients, and how you would lead your service within this new model.

What has been published

NHS England’s Medium Term Planning Framework: Delivering change together 2026/27 to 2028/29 sets the ground rules for the next three years. It couples a multi-year financial regime with explicit performance trajectories and a new operating model that pushes digital access, neighbourhood health and productivity improvement together. The central theme is to use reform to accelerate delivery now, not later, and to hard-wire change into local plans that boards must sign off and assure. High-level priorities and five-year strategic aims are to be reflected in trust-level plans, with performance and finance triangulated and board accountability strengthened. 

What is being announced, highlighted or changed

The framework sets out a package rather than a single policy. First, it resets finance and productivity: a multi-year settlement moves planning away from single-year cycles and locks in a minimum 2 percent productivity improvement each year, with transparent reporting of deficit support and a clear expectation that organisations reach balanced or surplus positions across the period. This is described as the biggest shake-up of the financial regime in more than a decade. Pages 8 to 11 and 13. 

Second, it rewires incentives by proposing a new urgent and emergency care payment model with a fixed element and a 20 percent variable element, new best-practice tariffs that shift activity to day cases and outpatients, and movement toward fair share allocations. Page 9 to 10. 

Third, it commits to dated performance improvements across diagnostic waits, urgent and emergency care and ambulance response, with consistent provider-level targets to lift performance and reduce long waits. Pages 29 to 31. 

Fourth, it makes digital by default a delivery requirement. Providers must fully adopt NHS App capabilities, migrate communications to NHS Notify, use the Federated Data Platform for warehousing and coordination, and implement AI-assisted triage within a unified access model, with milestones through 2028/29. Pages 18 to 20. 

Finally, it accelerates neighbourhood health with a 12-hour community urgent care offer supervised by senior clinicians, focused action on frailty, care homes and housebound cohorts, and the expectation of contract-backed integrated neighbourhood teams. Pages 15 to 17. 

How this adds to what is already known

Many strands have been signalled before, but the framework binds them together and dates them. Delivery targets are paired with the levers to hit them: new payment mechanisms, explicit digital adoption milestones, neighbourhood health requirements, and a productivity floor that applies every year. In practical terms, it gives permission and pressure to redesign outpatients, expand advice and guidance and straight-to-test models, and run a digitally led access model that reduces low-value follow up while protecting safety and equity. It also brings planning discipline: first submissions with three-year workforce, performance and finance trajectories and board assurance, followed by full plans in early February. Pages 38 to 39. 

Implications for the NHS system, trusts and professionals

At system level, incentives and oversight are aligned to reduce variation, grow productivity and shift capacity nearer home. The Oversight Framework is being refined to show comparative performance and support improvement, and to measure the three shifts of the 10 Year Health Plan more explicitly. Pages 12 and 15.

For trusts, the message is operational: redesign access so patients hit the right service first time, scale advice and guidance before referral in high-volume specialties, expand straight-to-test and one-stop models, and use CDC capacity fully with extended hours. Outpatient follow up is expected to change significantly, with patient-initiated follow up and digital reviews becoming the norm, not the exception. Pages 26 to 29. 

For consultants, the framework points to leadership on four fronts.

1. Triage and access: agree clear inclusion criteria, red flags and conversion thresholds so digital pathways remain safe.
2. Partnership with neighbourhood teams: design frailty and community urgent care handoffs that reduce avoidable bed days and protect elective flow.
3. Digital practice: normalise App-based management, questionnaires and messaging while guarding against hidden workload and digital exclusion.
4. Productivity and job planning: track activity against plan, lift theatre productivity and reduce length of stay, while protecting training time through supervised lists and observed clinics. Pages 18 to 20, 26 to 27 and 36.

Interview relevance

Panels will use this reset to explore whether you can translate national direction into credible local action. Expect to be asked how your pathway will become digital first where safe, how you will reduce low-value follow up, how you would work with neighbourhood health to reduce non-elective demand, and how you would hit the productivity floor without eroding training. Referencing the framework’s tools shows you are not simply asking for more staff, but are prepared to use the levers now in the system. Pages 8 to 11, 15 to 20 and 26 to 31.

Possible interview questions

• Which parts of your pathway will you move to digital first, and what conversion rules to face to face will you set to protect safety and equity
• How will you expand advice and guidance and straight-to-test in your specialty, and what will you track monthly to prove it is working
• How will you link your service to neighbourhood urgent care and frailty teams to reduce non-elective bed days and protect elective lists
• How will you deliver the 2 percent productivity ambition while safeguarding supervised training and staff morale

Guidance for candidates on using this information

Ground one or two concrete actions in the framework language. For example, “We will expand advice and guidance and move stable follow up to patient-initiated models, then repurpose capacity to reduce 52-weekers.” Or, “We will implement a frailty handoff with a 12-hour community urgent care offer and ring-fence elective theatres, tracking conversion time and bed days.” Use the App milestones to show how you will communicate with waiting patients and reduce DNAs, and use the productivity requirement to justify standardised templates and activity tracking. Pages 18 to 20, 26 to 31 and 13.

Summary

The framework ties money, targets and methods together. It expects digital by default where safe, neighbourhood health at pace, and a measurable productivity lift each year. For consultants, success will come from redesigning access and follow up, protecting safety and equity across digital and in-person care, and partnering with neighbourhood teams to reduce avoidable demand. If you can explain those changes in your specialty and how you will track them, you will sound current, credible and practical. Pages 8 to 12, 15 to 20 and 26 to 31.

Reference
https://www.england.nhs.uk/publication/medium-term-planning-framework-delivering-change-together-2026-27-to-2028-29/ 

Cheat Sheet: how to say this in interview

“We will make our pathway digital first where it is clinically safe, with clear conversion rules and patient-initiated follow up to free capacity.”

“We will expand advice and guidance and straight-to-test, then track backlog movement and new patient throughput.”

“We will partner with neighbourhood urgent care and frailty teams to reduce bed days and protect elective lists.”

“We will standardise templates and track activity to plan, meeting the 2 percent productivity ambition while safeguarding supervised training.”

How we help candidates prepare for their consultant interview

We help resident doctors and consultants prepare for their consultant interview through an extremely comprehensive NHS interview skills course and preparation programme, as well as coaching where desired. Calls like this framework are exactly why members tell us our approach saves them time and makes their answers stronger. We monitor national sources and translate the myriad of moving parts into practical, interview-ready insight. 

Our programme uses our proprietary and unique 8P approach to ensure absolute and maximal readiness. It includes:

• Planning – your whole interview preparation strategy to maximise effectiveness
• Principles – a full interview skills video course split into helpful sections or topics
• Priorities – constantly updated insight into the NHS and key issues such as demand, workforce, safety, access and digital change
• Pursuing – for those still applying for posts, optimising your application to ensure shortlisting
• Panelling – ensuring your pre-interview visits and conversations serve you well whilst guarding against common pitfalls
• Presenting – tackling the near-universal 10-minute presentation confidently
• Preparing – a vast bank of questions (over 300, constantly updated), cheat sheets and rehearsal scenarios
• Pausing – to learn from feedback and refine your approach until success is achieved (hopefully, with our support, you never even need this section)

This article is one example of how we keep you current and help you turn national policy into credible local actions you can talk about with confidence. If you want the whole methodology with templates, lived examples and coaching, see our NHS Consultant Interview Course.

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