Although the government has pledged to meet NHS England's demand for £8bn a year more funding for the NHS by 2020, Mr Stevens said there was 'no likelihood' that extra money would be made available this year beyond the £2bn announced last December by the Treasury.
Speaking at the NHS Confederation conference in Liverpool on Wednesday, he said putting the NHS on a sustainable financial footing, redesigning care and more preventive healthcare were the three key priorities.
He said in some areas 'honest conversations' about capacity, demand and activity had not happened last year and that the NHS would have to have 'difficult conversations' with CCGs about realistic funding.
NHS success regime
Three areas have been placed into the NHS 'success regime', which aims to provide 'increased direction and support to the most challenged systems'.
The three areas - Essex, North Cumbria and North, East and West Devon - will need to show short-term improvement against agreed quality, performance and financial metrics, adopt new care models and develop leadership.
Mr Stevens also used the speech to urge areas to come forward to become 'vanguard' trial sites to overhaul urgent care, including GP out-of-hours services. 'We need to redesign the way our urgent care system works,' he told the conference. 'The current system is confusing the public. We have to do a better job of joining it up. We need to simplify the urgent care spaghetti so we can manage the demands being placed on us.'
Mr Stevens reiterated his view that primary care had long been underfunded. The NHS had often been 'penny-wise and pound-foolish - not least in underfunding primary care'.