Jan 74 min read

NHS Elective Care Reform 2025: What You Need to Know

Updated: 3 days ago

As always, I write blogs for new primary care network (PCN) managers, administrators, clinical directors, and those interested in PCNs. This blog focuses on the "Reforming elective care for patients" document published on 6th January.

With over 6 million people currently waiting for care, this represents a significant service delivery transformation. The reform aims to tackle the elective care backlog and sets an ambitious target of the 18-week referral-to-treatment standard by March 2029.

In this blog, we cover:

1️⃣ Key Reform Aims

2️⃣ The NHS Elective Care Reform Commitment

3️⃣ Implementing Advice and Guidance

4️⃣ Digital Integration Challenges

5️⃣ Workforce Implications

6️⃣ The importance of reading these documents

Let's jump in!

Teal graphic with white text: "NHS Elective Care Reform 2025: What You Need to Know." Papers and folders in the blurred background.

The Core Reform Aims at a Glance

Patient empowerment through enhanced NHS App functionality and choice
Shift towards community-based care
Digital transformation of referral pathways
Integration of primary and secondary care services
Focus on productive and efficient care delivery

Key NHS Elective Care Reform Commitments

NHS England Will:

Launch 17 new surgical hubs by June 2025
Extend CDC hours to 12/7 operation by March 2026
Add 13 DEXA scanners for bone density
Pay GPs £20 per A&G request
Make NHS App the default for referrals
Target 85% acute trusts connected to NHS App by March 2025

Integrated Care Boards Will:

Implement new CDC standards by March 2026
Optimise referrals using A&G
Reduce health inequalities
Contract with independent sector providers

Providers Will:

Name director responsible for patient experience by April 2025
Enable NHS App appointment viewing by March 2025
Implement PIFU standard across pathways by March 2026
Make customer care training available
Standardise remote consultations

Performance Targets:

65% of patients within 18 weeks by March 2026
92% within 18 weeks by March 2029
Minimum 5% improvement per trust by March 2026
70% elective appointments viewable on NHS App by March 2026

Digital Integration:

Federated Data Platform adoption by 85% of trusts by March 2026
Enhanced e-RS functionality
Digital patient engagement portal implementation

Implementing Advice and Guidance

The reform introduces new financial incentives, with GPs receiving £20 per Advice & Guidance request. This aims to increase specialist advice requests from 2.4M to 4M by 2025/26.

However, there are challenges with Advice and guidance, which had been explored in the Pulse PCN article in October 2023, titled "The agony around advice and guidance", which highlighted:

Increased GP workload: Additional appointments, detailed assessments, and administrative tasks
Medicolegal risks: GPs retain responsibility for patients they may not feel equipped to manage
Patient dissatisfaction: Complaints when direct specialist referrals are blocked
Response delays: Consultant replies can take weeks, creating uncertainty
Contract misalignment: Forces GPs to provide unfunded outpatient services
Loss of clinical autonomy: Reduces GPs' decision-making authority
Limited effectiveness evidence: MPs note lack of proven benefits
Hidden waiting lists: Used to artificially protect secondary care waiting times
Documentation burden: Requires extensive record-keeping for legal protection

If you want to see/hear some more clinical perspectives, please check out the LinkedIn post by Dr. Hussain Gandhi.

Digital Integration Challenges

While the NHS App boasts 80% registration among adults, monthly usage remains below 20%. This presents a significant challenge to achieving the target of making 70% of elective appointments viewable through the app by March 2026, and the Darzi Report highlights this as a critical area requiring improvement.

Increasing digital engagement has been an area of attention since COVID-19, with many practices and PCNs utilising social prescribing teams, care coordinators, and patient-led digital champions.

Workforce Implications

The document cites the following requirements:

Customer care training for non-clinical patient-facing staff
e-Referral Service (e-RS) training for referral/booking management
NHS IMPACT training for 8,000 clinical and operational leaders in elective pathway management
Training on digital tools, including NHS App, patient engagement portals
Clinical staff training for independent practice and reformed ways of working

Organising Investigations

The process and permission levels for all required non-GP clinicians to be enabled to request an investigation to support advice and guidance also need to be in place, as this is a challenge I have personally encountered.

Final Thoughts

This document is another great example of why it's important for PCN leaders who do not work at the coalface of practice to read documents like The Darzi Report, The NHS Long-Term Workforce Plan and other NHS guidance documents and not just focus on the nuts and bolts of the PCN DES.

Everything that affects practices has a knock-on effect on the work, engagement, and the perceived advantages and disadvantages of working as a network.