Key changes in the 2026/27 NHS Standard Contract

2026/27 NHS Standard Contract: Key Changes

NHS England (“NHSE”) launched its consultation on the 2026/27 NHS Standard Contract and Technical Guidance in November 2025. Following the conclusion of the consultation process, NHSE published final versions of the 2026/27 NHS Standard Contract and Technical Guidance on 28 January 2026. 

This update is relevant for all providers, whether they are NHS Trusts or from the independent sector, who perform services for the NHS.

Key Changes to the NHS Standard Contract

Activity Management Provisions:

As part of the 2026/27 NHS Standard Contract consultation NHSE proposed a number of changes to the activity management provisions and most notably:

1. removal of the Escalation Process which providers can invoke where the Commissioner has set an IAP and/or AMP and the provider considers that the Commissioner has not complied with the relevant process set out in the Technical Guidance; and
2. amending the NHS Standard Contract Service Conditions to enable Commissioners to agree or set an IAP for multiple different parts of a contract.

These proposals have not been implemented. NHSE has not provided detail as to why these proposals have been withdrawn. However, we understand concerns were raised that these proposals could result in longer dispute processes. This could have resulted in providers being required to adhere to IAPs and AMPs that had been set by a Commissioner (without agreement from the provider) for significantly longer periods of time than is currently the case. In the case of a set AMP, this could have resulted in prolonged periods of non-payment, even if the setting of the AMP did not comply with the NHS Standard Contract requirements and guidance.  

Commissioners are now contractually required to comply with the obligations at paragraphs 42.25 and 42.38 of the Technical Guidance when setting IAPs and/or AMPs. This amendment  gives greater weight to these requirements which Commissioners were previously only required to take into account.  Providers should note that timescales in which an AMP can be set has been reduced from 10 Operational Days to the next Operational Day where:

1. the provider and Commissioner are unable to agree an AMP at a Joint Activity Review; or
2. the provider does not attend either the meeting to discuss an Activity Query Notice or the Joint Activity Review without reasonable notice or explanation.

In addition, NHSE has amended the 2026/27 Technical Guidance to include additional guidance which clarifies the escalation criteria and when the Escalation Process should be used. In summary:

1. Escalations which relate to a general disagreement rather than any of the grounds for escalation will be unsuccessful. Given the limited nature of the grounds for escalation, this is perhaps an unwelcome clarification for providers. 

2. Commissioners must ensure that they have sought to fully engage with providers and consider their responses before setting an IAP and/or AMP. This is more helpful for providers, even if there remains some ambiguity over what full engagement will mean in practice. It should mitigate the risk, for example, of Commissioners not engaging at all, only to attempt to set an IAP or AMP. 

3. If a Commissioner intends to reduce activity, the Commissioner is not obliged to share their full analysis of demand, capacity and impact of waiting times with providers. Rather, commissioners are required to explain the steps they have taken and share any conclusions reached, if requested. Again, this is not helpful for providers. If that analysis has been carried out and forms the basis of a decision to limit provider activity, it is not clear what the benefit of this decision is. Unless the analysis is made available, how can a provider have confidence in the conclusions that have been reached? If that information exists, it will potentially be subject to disclosure under the Freedom of Information Act anyway. One might think this is an attempt to reduce the scope for providers to escalate decisions, when it may have been better for the system as a whole to ensure that the analysis was clear, robust and shared with providers. 

4. Providers are expected to co-operate with Commissioners in attempting to deliver activity within the IAP and/or AMP in place. 

5. It is for Commissioners to decide the level of impact assessment required, but they should discuss their decision with providers and give providers the opportunity to give their views on these impacts.

The deadline for agreeing an IAP for 2026/27 for existing contracts is 1 April or for new contracts, before the service commencement date.

Local and National Quality Requirements:

For 2026/27 Commissioners can set local variations to certain National Quality Requirements where a different target has been agreed with NHSE as part of the annual planning round. If a local target is set, these will take precedence over the National Quality Requirement – although, Commissioners and providers should work towards achieving national targets where possible. This change formalises the shift we have seen throughout 2025/26 with Commissioners seeking to implement local waiting times.

The number of National Quality Requirements impacted by this change are limited but includes the national 18-week referral to treatment target and diagnostic test waiting times.

Practical Guidance for Providers

Given the proposed changes to the activity management provisions have been scaled-back, we do not expect to see great changes from the 2025/6 Contract Year. It will be important for providers to:

• continue to seek early engagement with Commissioners and ensure robust data sets of historic and anticipated activity levels are available to support discussions with Commissioners; and

• be aware of the information Commissioners are required to provide as part of the IAP and AMP processes and be proactive in requesting the steps that Commissioners’ have taken and their conclusions in relation to demand, capacity and impact on waiting times where a reduction in activity is being proposed.

If you would like to discuss any of the above, please contact a member of our Healthcare Team.

This article was written by Lisa Mulholland and Patrick Parkin.