The NHS operating framework for 2010-11 is expected to include “hard hitting” measures to cut the cost and number of hospital procedures and tackle inefficiencies in community health services.

Headline messages from the operating framework are due to be issued to senior NHS managers today, with the detail published next week.

As HSJ revealed in October, the centrepiece is expected to be a “two part” NHS tariff capping the volume of emergency procedures trusts will be paid for at full tariff price at 2008-09 levels. Patients over that volume will be paid for at so-called “marginal cost”, expected to be defined nationally at 50 per cent.

NHS tariff prices are also expected to be frozen, with no increase to account for inflation. Instead trusts will only be able to increase their unit payments by a maximum of around 1.5 per cent if they meet the requirements of the CQUIN (commissioning for quality and innovation) scheme.

The moves attempt to shift the balance of power away from trusts and foundation trusts towards primary care trust commissioners.

Although it has been Department of Health policy for several years to increase PCT allocations by a much greater proportion than tariff inflation, acute hospitals have eaten into the vast majority of the difference by increasing the volume of patients they treat. That has left PCTs with little or no funds for preventive services or to shift care into the community.

But the framework will also tackle inefficiencies among community services, which will be told they need to reduce their unit costs year on year.

PCT commissioners will be told they must focus on providing patients with the “right care”, requiring them to decommission services and treatments that bring little benefit to patients. There will be a new emphasis in the world class commissioning framework for PCTs to develop comprehensive strategies for dealing with leaner finances.

It will also set out significant cuts to DH central budgets and those of strategic health authorities, which will be billed as needed to protect “frontline services”. Cuts to the DH’s own administrative and back office costs could be used as the example - or target - for the NHS to follow.