Purple Guide 2026 Medical Changes: What’s Changed – and What It Means for Event Organisers
If you organise events in the UK, chances are you’ve heard of the Purple Guide. In this article we break down the Purple Guide 2026 medical changes in plain English – what’s actually different, and what it means for your event medical cover. It’s the industry bible for event safety – and when it updates, it matters.
In January 2026, a revised version of the Medical chapter was released. At first glance, it looks reassuringly familiar. No dramatic rewrites. No radical new rules.
But look a little closer and you’ll spot something important: the language has tightened, expectations have sharpened, and the direction of travel is very clear.
Here’s a plain‑English breakdown of what’s actually changed – and what you should be doing about it.
1. Purple Guide 2026 Medical Changes: The NHS Is No Longer Your Backup Plan
One of the strongest themes in the 2026 update is this:
“Organisers should provide a safe, effective and resilient medical service which minimises the impact of the event on the local NHS.”
That sentence existed before, but it’s now front and centre.
What this means in practice:
If your medical provision relies heavily on calling 999 for anything beyond a plaster and a cup of tea, you’re now on much thinner ice.
Safety Advisory Groups (SAGs) are increasingly asking:
- Can this team genuinely treat and discharge patients on site?
- Are they staffed with clinicians who can make proper clinical decisions?
- Or are they just acting as a triage funnel into an already stretched NHS?
Bottom line:
Events are expected to be more self‑sufficient. Higher‑skill medical teams aren’t a luxury anymore – they’re becoming the new normal.
2. A Clearer Line on CQC Registration and Ambulances
The 2026 guidance is much more explicit about regulation:
- On‑site first aid and treatment (TDDI): still exempt from CQC registration.
- Off‑site patient transport to hospital: very likely a CQC‑regulated activity in England.
Why this matters:
We still see providers advertising “ambulances” who:
- Aren’t CQC‑registered
- Don’t have governance systems
- And shouldn’t legally be conveying patients to hospital
The updated Purple Guide wording strengthens organisers’ duty to look beyond a simple “Are you CQC registered?” tick‑box.
What you should be asking your provider:
- Who actually provides hospital transfers?
- Are they CQC‑registered for patient transport?
- What happens if your on‑site ambulance leaves the site – what cover is left behind?
3. Minimum Qualifications Are Now Less ‘Flexible’
The guide now states more firmly that:
- PHEM Level D (e.g. FREC 3) is the minimum for unsupervised work at licensed events
- Lower‑level qualifications (FAW, CFR, etc.) are generally not suitable except:
- At Tier 1 events
- Or when directly supervised
Why this is a big deal:
This quietly undermines the “stack them high with first aiders” approach that some low‑cost providers still use.
It also gives organisers stronger footing to say:
“No – we’re not comfortable with a licensed event being covered by FAW staff alone.”
Reality check:
Better‑qualified staff = fewer hospital transfers = better attendee experience = less pressure on local NHS services.
It’s not just safer. It’s usually more cost‑effective in the long run.
4. You’re Expected to Have Proper Medical Leadership
The 2026 update sharpens expectations around command and control.
At larger or more complex events:
- The Clinical Lead should not also be doing hands‑on clinical shifts
- The medical provider should be represented in Event Control
Why this matters:
This moves the sector away from the “hero paramedic doing everything” model.
You’re now expected to have:
- Someone overseeing the whole medical operation
- Someone focused on clinical governance and escalation
- Someone coordinating with control, safety officers and emergency services
In plain terms:
Medical cover is now being treated as a system – not just a few people with kits.
5. Dedicated Medical Radio Channels Are No Longer Optional
The wording on communications has also tightened.
The guide now says that:
- Medical resources should be dispatched on a reserved radio channel
- Shared channels are “rarely acceptable”
- There are explicit GDPR concerns around shared comms
Why this matters:
If your current setup is:
- “Just shout it over the steward channel”
…that’s now a compliance risk.
What SAGs are starting to expect:
- A dedicated medical talkgroup
- Clear call‑signs
- Logged medical tasking
- Some level of data protection awareness
6. Stronger Push Against Routine 999 Use
The 2026 version is more direct about this:
The 999 NHS ambulance service should only be called when, in the opinion of the senior clinician on duty, this is needed to ensure patient safety.
Why this is important:
It reinforces that:
- NHS ambulances are not a default transport service for events
- Senior clinicians on site should be making transfer decisions
- Organisers are expected to plan alternative transport options
This again points toward higher‑skill teams and proper clinical governance.
7. More Weight on Contingencies and Major Incidents
The new version gives greater prominence to:
- Capacity for unexpected contingencies
- Major incident escalation
- Ten Second Triage and immediate life‑saving interventions
What this means for you:
Your medical plan is no longer just about:
- “How many first aiders do we need?”
It’s now also about:
- What happens if something really goes wrong?
- Who takes command?
- How do you scale up quickly?
- How do you protect the rest of the site while managing a serious incident?
So… Have the Purple Guide 2026 Medical Changes Really Changed Everything?
No.
But the direction of travel is crystal clear.
The Purple Guide is steadily moving the UK events industry toward:
- Fewer low‑skill, first‑aid‑only models
- More clinician‑led medical teams
- Stronger governance and command structures
- Greater self‑sufficiency from the NHS
- Higher expectations from organisers
What Should Event Organisers Do Now About the Purple Guide 2026 Medical Changes?
Here’s the practical, no‑nonsense checklist:
- Review your current medical provider
Ask them how they align with the 2026 Purple Guide – not just the 2024 version. - Challenge low‑skill staffing models
Especially for licensed events or anything Tier 2 and above. - Ask hard questions about ambulances
- Are they CQC‑registered for transport?
- What happens if one leaves site?
- Check your comms plan
If you don’t have a dedicated medical channel, fix that. - Upgrade your medical plan
Make sure it properly covers:- Escalation
- Major incidents
- Command and control
- Contingencies
Final Thought on the Purple Guide 2026 Medical Changes
The Purple Guide hasn’t suddenly turned the industry upside down.
But it has quietly raised the bar.
If your medical provision still looks like it did five years ago, you’re probably already behind the curve.
And if you’re not sure whether your current setup would pass a modern SAG review… that’s your warning light right there.
Want a second opinion on your current medical cover or medical plan?
We’re always happy to sense‑check it against the latest Purple Guide guidance – no hard sell, no nonsense, just straight answers.
Drop us a message or book a quick call and we’ll walk through it with you.
Helpful Resources
- The Purple Guide to Health, Safety and Welfare at Music and Other Events
- Health and Safety Executive – Event Safety Guidance