The February 2026 NHS England Board papers present a clear headline: acute providers delivered 2.4% productivity growth at Month 3 (M3) year-to-date, compared with the same period in 2024/25. 

This sits within a national context in which the government has set a 2% productivity requirement, and NHS England is embedding that expectation into planning, oversight, and payment mechanisms. 

At face value, this suggests the system is meeting the direction of travel. 

However, the same Board pack also contains workforce signals that complicate the picture: 

• GP leaver rate at 6.6% (1,812 FTE) in December 2025, higher than September 2025. 
• Sickness absence rates worsening compared with the previous year. 
• Staff engagement indicators showing decline in recent surveys, as referenced in the IPR narrative. 

The message is not contradictory. It is structural. 

Four system signals define the current productivity–workforce position. 

 

Signal 1: Measured productivity growth is above target at M3 

The Integrated Performance Report states that at M3 2025/26, acute providers delivered 2.4% productivity growth compared with the same period the previous year. 

The Productivity Plan update paper frames this within a multi-year ambition to: 

1. Close the gap back to 2019/20 productivity levels. 
2. Level up lower-performing providers. 
3. Move beyond the current productivity frontier through digital and operational redesign. 

The report also highlights actions contributing to productivity gains, including: 

• Improved job planning compliance. 
• Reduced reliance on temporary staffing. 
• Targeted operational support and opportunity packs for providers. 

This signal is important. 

The productivity conversation has moved from recovery rhetoric to quantified delivery. 

A 2.4% increase at M3 indicates measurable change, not aspirational planning. 

 

Signal 2: Temporary staffing reduction is a lever, but not a substitute for capacity

The Board papers reference reductions in temporary staffing and improvements in job planning compliance as part of the productivity story. 

Reducing agency and bank expenditure can improve cost efficiency. It can also increase continuity of care and reduce unwarranted variation. 

However, this lever has limits. 

Productivity improvement derived from tighter workforce controls is structurally different from productivity derived from: 

• Pathway redesign 
• Digital workflow integration 
• Reduced duplication 
• Demand management 

The Productivity Plan paper makes clear that technology alone does not generate benefit without implementation discipline. 

This signals that productivity growth at M3 is likely the result of multiple levers operating simultaneously. 

The sustainability question is whether those levers remain available at the same scale in subsequent quarters. 

 

Signal 3: Workforce stability indicators are under pressure 

While productivity is improving, workforce signals are mixed. 

The Integrated Performance Report shows: 

• GP leaver rate of 6.6% (1,812 FTE) in December 2025, higher than the September 2025 position. 
• Worsening sickness absence rates compared with the previous year. 

In addition, the IPR references declining engagement indicators in recent staff surveys, noting established relationships between engagement, productivity and patient experience. 

Taken together, this suggests: 

• Productivity growth is occurring within a workforce environment that remains strained. 
• Gains may be partly driven by tighter management rather than expanded staffing capacity. 

This is not a critique. It is a structural observation. 

If sickness absence rises and leaver rates increase in key sectors such as general practice, productivity expectations must be delivered within a tighter labour envelope. 

 

Signal 4: Payment and oversight mechanisms are reinforcing productivity expectations 

The February Board pack situates productivity within a broader financial and planning discipline. 

The Month 9 financial paper reiterates the requirement for systems to deliver their plans and references Deficit Support Funding (DSF) consequences where performance falls short.  

The Productivity Plan update aligns with payment scheme efficiency factors and provider-level opportunity packs. 

This indicates that productivity is not framed as optional improvement activity. 

It is embedded in: 

• Financial balance expectations 
• Planning assumptions 
• Oversight segmentation 
• Efficiency factors within payment models 

The system signal is therefore firm: productivity growth must continue. 

 

Signal 5: Community and flow pressures complicate the equation 

Previous blogs ‘Faster ambulances, slower flow the UEC tension remains’ and ‘Community backlogs are now a strategic risk’ highlighted: 

• Persistent 12-hour ED waits. 
• Rising community 52-week waits (+56.8% year-on-year). 

These pressures influence productivity in two ways: 

1. Flow constraints reduce effective bed availability and increase internal inefficiency. 
2. Community capacity constraints limit discharge and increase acute utilisation. 

Productivity metrics may show improvement in isolation. But whole-system productivity depends on stable flow across settings. 

The Board papers collectively indicate that while acute productivity is improving, community and discharge constraints remain material. 

This creates a more complex delivery environment for 2026/27. 

 

What this means now 

The February 2026 Board pack presents a system that is delivering measurable productivity growth while operating within ongoing workforce and flow constraints. 

For system leaders, three implications stand out. 

1. Productivity is now baseline expectation 
   • A 2.4% increase at M3 demonstrates that productivity growth is achievable in-year.
     Future planning cycles will assume similar or greater gains. 
   • This resets expectations.
2. Workforce sustainability must sit alongside efficiency 
   • Rising GP leaver rates and sickness absence trends indicate workforce stability remains fragile. 
   • Efficiency gains that are not accompanied by workforce resilience risk erosion over time. 
3. Productivity cannot be separated from system flow 
   • Acute productivity gains may be undermined if discharge and community constraints persist. 
   • Whole-system productivity depends on coordinated capacity across acute and community settings. 

Strategic exit 

The Board papers suggest that the NHS has entered a different phase of the productivity debate. 

The question is no longer whether productivity can increase. The data shows it can. 

The leadership question is whether productivity growth can be sustained: 

• Within existing workforce constraints 
• While reducing reliance on temporary staffing 
• While stabilising community and discharge capacity 
• Under tighter financial and oversight discipline 

Productivity growth is now a baseline expectation. The leadership task is to sustain it while strengthening workforce resilience and whole-system flow. 

References 

1. NHS England. Integrated Performance Report, Board Paper, February 2026 (Item 4.1). 
   • Acute productivity growth (M3 2025/26: +2.4%). 
   • GP leaver rate (Dec 2025: 6.6%, 1,812 FTE). 
   • Sickness absence and engagement commentary. 
   • ED 12-hour waits (Dec 2025: 10.5%). 
   • Community 52-week waits (Nov 2025: 87,125; +56.8% YoY). 
2. NHS England. Productivity Plan – Update, Board Paper, February 2026 (Item 5). 
3. NHS England. Month 9 Financial Position 2025/26, Board Paper, February 2026 (Item 4.2).