The BMJ Commission on the Future of the NHS examines the challenges facing the NHS in the UK, including increasing demand, rising costs, and deteriorating performance. The NHS has grown from 3.2% of GDP in 1950 to 9.3% in 2022, driven by population growth, medical advancements, and higher healthcare inflation. Despite this, public support for a tax-funded NHS remains strong, with 82% of people in the UK supporting this model. The Commission recommends maintaining the current funding model, primarily through taxation, to ensure the sustainability of the NHS. The Commission also highlights the need for a new independent body, the Office for NHS Policy and Budgetary Responsibility (OPBR), to oversee NHS funding and provide regular reports on the state of the NHS, healthcare, and long-term funding projections. This body would help ensure transparency, accountability, and informed decision-making in NHS funding. The Commission recommends a five-year strategic plan for the NHS, with a detailed financial settlement and a provisional settlement over the five to 10-year horizon. Immediate funding injections are also needed to address the current NHS crisis, particularly the surgery backlog and access to primary care. The Commission emphasizes the importance of public engagement in the decision-making process and the need for a long-term vision for the NHS that balances healthcare spending with other public priorities. The Commission concludes that the NHS must continue to be funded primarily through taxation to ensure its sustainability and to meet the needs of the population. It also calls for a long-term strategic plan that includes a five-year financial settlement and a focus on improving healthcare outcomes, reducing waiting times, and addressing workforce and infrastructure challenges. The Commission highlights the importance of public engagement and the need for a transparent, accountable approach to NHS funding.The BMJ Commission on the Future of the NHS examines the challenges facing the NHS in the UK, including increasing demand, rising costs, and deteriorating performance. The NHS has grown from 3.2% of GDP in 1950 to 9.3% in 2022, driven by population growth, medical advancements, and higher healthcare inflation. Despite this, public support for a tax-funded NHS remains strong, with 82% of people in the UK supporting this model. The Commission recommends maintaining the current funding model, primarily through taxation, to ensure the sustainability of the NHS. The Commission also highlights the need for a new independent body, the Office for NHS Policy and Budgetary Responsibility (OPBR), to oversee NHS funding and provide regular reports on the state of the NHS, healthcare, and long-term funding projections. This body would help ensure transparency, accountability, and informed decision-making in NHS funding. The Commission recommends a five-year strategic plan for the NHS, with a detailed financial settlement and a provisional settlement over the five to 10-year horizon. Immediate funding injections are also needed to address the current NHS crisis, particularly the surgery backlog and access to primary care. The Commission emphasizes the importance of public engagement in the decision-making process and the need for a long-term vision for the NHS that balances healthcare spending with other public priorities. The Commission concludes that the NHS must continue to be funded primarily through taxation to ensure its sustainability and to meet the needs of the population. It also calls for a long-term strategic plan that includes a five-year financial settlement and a focus on improving healthcare outcomes, reducing waiting times, and addressing workforce and infrastructure challenges. The Commission highlights the importance of public engagement and the need for a transparent, accountable approach to NHS funding.