Operating Framework for the NHS

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081094

This explicitly moves to a more hands-off approach allowing more local discretion. So there will a small number of national priorities, and then areas for local PCT prioritisation and flexibility. However, when you look at it, it still seems like a lot of national direction (given all the previous must-dos don't go away). It is a step in the right direction though.
There will be a "vital signs" document soon, or indicators to encourage joint working with local authorities.

A. The must dos:

improving cleanliness and reducing HCAIs;
improving access through achievement of the 18-week referral to treatment pledge, and
improving access (including at evenings and weekends) to GP services;
keeping adults and children well, improving their health and reducing health inequalities;
improving patient experience, staff satisfaction, and engagement;
preparing to respond in a state of emergency, such as an outbreak of pandemic flu.

B. The issues that PCTs need to consider whether local recovery action is required:

equality
mixed-sex accommodation
learning disabilities
diabetic retinopathy
Mental health crisis resolution

C. Issues that are on the horizon that need to be considered by PCTs

mental health - improving access to psychological therapies (IAPT)
older people - dementia - earlier intervention
end of life care (new strategy mid 2008)
disabled children

D. Then there are the existing targets

Existing commitments
" Whilst there is a need to focus on new priorities, it is essential that the levels of service set through previous commitments, which should have been achieved by April 2008, are maintained. We will ask the Healthcare Commission to feed the following specific commitments into its performance assessment of NHS bodies, alongside its performance assessment of other issues: "

four-hour maximum wait in A&E from arrival to admission, transfer or discharge;

guaranteed access to a primary care professional within 24 hours and to a primary care doctor within 48 hrs € a maximum wait of 13 weeks for an outpatient appointment;

a maximum wait of 26 weeks for an inpatient appointment;

a three-month maximum wait for revascularisation;

a maximum two-week wait standard for Rapid Access Chest Pain Clinics;

thrombolysis 'call to needle' of at least 68 per cent within 60 minutes, where thrombolysis is the preferred local treatment for heart attack;

guaranteed access to a genito-urinary medicine clinic within 48 hours of contacting a service;

all patients who have operations cancelled for non-clinical reasons to be offered another binding date within 28 days, or the patient's treatment to be funded at the time and hospital of the patient's choice;

delayed transfers of care to be maintained at a minimal level;

all ambulance trusts to respond to 75 per cent of Category A calls within 8 minutes;

all ambulance trusts to respond to 95 per cent of Category B calls within 19 minutes;

a two-week maximum wait from urgent GP referral to first outpatient appointment for all urgent suspected cancer referrals;

a maximum waiting time of one month from diagnosis to treatment for all cancers;

a maximum waiting time of two months from urgent referral to treatment for all cancers;
100 per cent of people with diabetes to be offered screening for the early detection (and treatment if needed) of diabetic retinopathy;

deliver 7,500 new cases of psychosis served by early intervention teams per year;

all patients who need them to have access to crisis services, with delivery of 100,000 new crisis resolution home treatment episodes each year;

all patients who need it to have access to a comprehensive child and adolescent mental health service, including 24-hour cover/appropriate services for 16- and 17-year-olds and appropriate services for children
and young people with learning disabilities;

chlamydia screening programme to be rolled out nationally .

E. There's the new 0809 tariff

F. There is guidance on the duty of PCTs and local authorities to produce a Joint Strategic Needs Assessment (the key local needs assessment document)

G. And finally, Annex D has Principles and rules for co-operation and competition . This is an important - if slow - acknowledgement that managing the market needs some transparency and principles.