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The recently published operational planning guidance describes what the NHS needs to achieve this year. Wilmington Healthcare’s Oli Hudson explores some of its critical themes and what they mean for industry.

The arrival of the NHS operational planning guidance is a big moment in the health service calendar, firing the starting gun on the annual planning cycle by marking out the national priorities for the year. So what can this year’s document tell us about the future direction of travel for the NHS?

Core priorities

The central thrust of the 2022-23 planning guidance is built around a set of 10 core priorities that mesh the need to maintain an effective pandemic response with action to address the elective care backlog and manage pressures on health services, while at the same time supporting and growing a workforce battered by its two-year battle against COVID-19.

Supporting this, the NHS has already committed both funds and extra organisational capabilities to address the backlog challenge. This includes:

  • A £2.3 billion package of additional elective recovery funding to be distributed via Integrated Care Systems (ICSs);
  • a £1.5 billion capital funding boost for new surgical hubs, extra bed capacity and the expansion of elective hub sites and day-case units; and
  • additional capacity drawn from the private sector – NHS England has recently struck a short-term deal with a number of independent health companies allowing trusts to use private hospital facilities and staff to reduce waiting times.

The particular challenge of reducing waiting times is a central theme. The planning guidance sets an ambitious goal to deliver 10% more elective activity than before the pandemic, rising to 30% more by 2024/25 than before the pandemic, with a particular focus on reducing long waits in excess of 52 months.

There are also specific ambitions to reset cancer services, with systems being asked to return the number of people waiting longer than 62 days to pre-pandemic levels and increase referrals and treatments to reduce a shortfall in the number of patients coming forward for first treatment.

Meanwhile, a further £90 million is also being made available to improve the NHS’s ability to treat patients with long COVID more promptly, with an aim to increase the number of patients referred to post-COVID services and seen within six weeks of referral.

Transforming out of hospital care

Yet while much of the guidance is inevitably about addressing backlog pressures, there is also a significant focus on shaping the NHS for the future through the transformation of services, particularly through the use of technology and new ways of working.

Expanding and developing new forms of out-of-hospital care is a key part of this, and the planning guidance sets out several areas of reform, all intended to reduce the burden on hospitals and deliver more interventions ‘upstream’ to reduce unnecessary admissions. These include:

1. Virtual wards

A headline initiative for the planning guidance is a significant expansion in the use of virtual wards to deliver care remotely for patients with COVID and other acute respiratory infections, as well as urinary tract infections, COPD and complex presentations. These are set to be rolled out by provider collaboratives and will build on the 53 virtual wards already providing capacity for over 2,500 patients nationally.

2. Urgent community response

The LTP set a goal of all parts of the country having faster access to community health crisis response teams and the planning guidance returns to this commitment, setting an ambition to achieve a minimum of an 8am to 8pm service delivered seven days a week nationwide. The guidance also pledges to “improve capacity in post urgent community response services to support flow and patient outcomes including avoiding deterioration into crisis again or unnecessary admission.”

3. Anticipatory care

In a similar vein, the guidance also follows up the LTP’s commitment to improve ‘anticipatory care’: that is, proactive care in the community for multimorbid and frail individuals who would benefit most from integrated care to manage their condition(s) more effectively. ICSs are being asked to design, plan for and commission anticipatory care solutions for their system.

4. Supporting care homes

The planning guidance recaps on a longstanding pledge to improve the way care homes are supported. Primary Care Networks will be expected to provide improved on-site and virtual care, delivered by GPs, community and practice nurses, through the Enhanced Health in Care Homes framework. This is part of the new GP contract, funded as a Directed Enhanced Service (DES).

5. Community Diagnostic Centres

Building capacity in diagnostics services is also a significant priority. Systems have been asked to increase diagnostic activity to a minimum of 120% of pre-pandemic levels across 2022/23 – ambitious to say the least – and community settings are again key to this, with the lynchpin being the roll-out of new Community Diagnostic Centres (CDCs). Systems will get dedicated revenue funding to maintain these, as well as capital support for infrastructure and equipment.

Key implications for brand planning

So, what should industry take from all of this? Firstly, it’s important to stress these are conditional plans, and there is likely to be variation across systems and places when it comes to the capacity to deliver some or all aspects of these reforms in the face on ongoing operational / pandemic challenges. Understanding where different localities are in the journey is essential.

Secondly, the guidance is very explicit about the importance of “doing things differently”. The time is therefore ripe for transformed pathways, innovations and use of technology to deliver more effective care. For example, the remote monitoring of certain conditions, via virtual wards, is being primed to become a mainstream way of offering services across a range of disease pathways. Pharma should be looking at how its offer can support these ambitions.

Thirdly, changes to the profile and range of pharma’s customer base are likely to accelerate. Any radical expansion of community health will mean a new cast list of stakeholders and influencers. CDCs, for one, are likely to become important stakeholders and industry should check their remit and staffing locally, as they may well become the gatekeepers for certain pathways.

Similarly, with Primary Care Networks playing a central role in diagnostic recovery, we can expect community pharmacy to become more influential, for example in the delivery of care processes such as blood pressure measurement, as well as after care packages for people after they are discharged from hospital. Pharma should be renewing their stakeholder maps and CRM approaches to take account of this.

Finally, the guidance underlines the desire for systems to see their role in a much wider frame than ever before. Under the terms of the Health and Care Bill, all ICSs will be required to produce a one-year operating plan in April, and a five-year system plan to “improve outcomes in population health, tackle inequalities, enhance productivity and value for money and support broader social and economic development”. Both will be key documents for pharma to source and review.


Time will tell whether the transformational aspects of the guidance are achieved over the coming months. However, the intent to make further rapid progress in delivering new models of care is clear. Industry must be alive to this and ready to respond with a value proposition that reflects this ambitious agenda.

Wilmington Healthcare provides market leading data, insight and intelligence across the healthcare community. To find out more about how we can support your NHS partnerships, visit

10th February 2022



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