The NHS Standard Contract is the contractual basis on which Integrated Care Boards contract for all healthcare services other than primary care. Below, we have summarised the proposed changes affecting providers of health and social care services, which are funded wholly or partly by the NHS.

Contract management

Following feedback that the provisions in General Condition 9 were overly long and complex, NHS England has sought to simplify the Commissioners’ contract management provisions. Where the Commissioner and the provider have not (within 10 operational days of the relevant notice):

• attended a contract management meeting;
• agreed either a course of action or the terms of reference and timescale for a joint investigation;
• agreed a joint investigation report;
• agreed a remedial action plan;

Due wholly or mainly to the provider’s unreasonableness or failure to engage, it is proposed that Commissioners may withhold up to 10% of the expected monthly value or actual monthly value. Commissioners can withhold such sums for each further month that the failure to attend or agree continues. 

The drafting fails to acknowledge that the Commissioner can also act unreasonably or fail to engage with the contract management process and this has been raised by some participants during the consultation exercise. The proposed change bolsters Commissioners’ powers to ensure remedial action plans are agreed and actioned in a timely manner, whilst leaving providers with no meaningful, financial remedy to address Commissioner unreasonableness and/or a failure to engage with either the contract management or dispute resolution processes.

It has also been noted by some that withholding payment for the provider’s failure to engage or agree will only compound issues relating to financial distress. Rather than improving outcomes, this will cause providers to enter into costly borrowing arrangements in order to maintain cash flow during the interim, negatively impacting value for money when commissioning services over the long term.

Indicative Activity Plans

Indicative Activity Plans must be agreed for any ‘Services Paid for on an Activity Basis’. 

Previously, these plans needed to be agreed upon by the parties either before or within three months of the service commencement date. NHS England is now proposing that such plans can be agreed in part but cannot be agreed retrospectively. Where indicative activity or activity management plans cannot be agreed upon by the parties prior to the service commencement date, such plans can be set unilaterally by the Commissioner (in accordance with the technical guidance).

In circumstances where providers believed the Commissioner had not complied with the technical guidance, previous versions of the NHS Standard Contract allowed them to escalate the matter to an independent panel for review. Despite finding 50% of those escalations in favour of providers during 2025/26, NHS England is proposing to abolish the contractual escalation procedure in 2026/27. Instead, where Commissioners fail to follow the technical guidance, providers will need to engage the normal dispute resolution process and bring legal proceedings for breach of contract.

These changes do not change the fact that providers should be paid based on their actual activity levels, but they do undermine providers’ ability to influence Commissioner expectations and ensure there are sufficient resources in place to meet anticipated demand.

Quality requirements

National quality requirements have been updated to reflect new metrics set out in the Medium Term Planning Framework 2026/27 to 2028/29, affecting cancer and urgent care, as well as talking therapies. 

Commissioners are also expected to enter into local quality requirements, working towards the long-term targets agreed with NHS England. These include:

• no more than 1% of patients waiting over 6 weeks for a diagnostic test;
• at least 92% of patients receiving treatment within 18 weeks;
• 85% of patients waiting no more than 4 hours in A&E, as well as reducing the number who wait over 12 hours.

Equality Act 2010

Following a change in the law, employers are now legally required to take reasonable steps to prevent sexual harassment in the workplace, which includes third-party sexual harassment. This statutory duty is now explicitly referred to within Service Condition 13.3. Please contact a member of our team if you haven’t already arranged training for your managers and employees.

At the same time, providers are expected to implement the high-impact actions set out in the NHS Equality, Diversity and Inclusion Improvement Plan, reporting on any locally agreed action plans related to workforce EDI.

Health inequalities

NHS England and ICBs are required, as a matter of law, to take account of reducing health inequalities in the exercise of their functions. More information about these duties can be found here. There is a new, optional schedule in the Particulars (Schedule 2N) which allows the Commissioner and provider to incorporate a Health Inequalities Action Plan into the contract.

Martha’s Rule

Martha’s Rule is a patient safety initiative enabling patients, families and carers to request a rapid review if they are worried that their own or their loved one’s condition is getting worse, and their concerns are not being responded to.

A pilot has now been completed, with evidence suggesting that the implementation of Martha’s Rule in pilot sites has saved lives. NHS England is now proposing to require NHS Trusts and Foundation trusts to implement the three core components of Martha’s Rule by 31 March 2027. There is no proposal (at this stage) to roll this out to providers.

Safeguarding and green NHS

It will be mandatory for all NHS Trusts and Foundation Trusts to implement the Violence Prevention and Reduction Standard. There is no proposal (at this stage) to roll this out to providers. However, providers must proactively take steps to prevent abuse (including domestic abuse) by responding early to risk factors or indications of abuse or neglect in both children and adults: reinforcing the statutory and regulatory obligations that already apply to providers.

Providers of acute care services must use NHS England’s template forms to help capture capacity assessment and best interest assessments. The DAPB4042 Transfer of Care – Acute Inpatient Discharge Information Standard is now out of date. Trusts may choose to follow this standard, but it is no longer mandatory.

There will be a new requirement for Trusts to deliver capital investment that has been allocated to them, and a new reference included to a new toolkit published by NHS England to help Trusts reduce waste from piped nitrous oxide.

Next steps

Comments on the draft NHS Standard Contract 2025/26 should be submitted by 16 December 2025 via the NHS England online survey. 

Once the consultation has concluded, the new terms should be published shortly and will apply to the 2026/27 financial year for all new contracts. The updates will automatically apply to any existing contracts that continue into the 2026/27 financial year, without the need to sign a contract variation.