There could be problems with the 'nuts and bolts', of the new commissioning framework for health and well-being, according to the man responsible for its introduction.

Department of Health head of demand-side reform Bob Ricketts told two regional consultations on the framework that some staff had struggled with a lack of detail in it. He said local services should decide how commissioning moves from primary care trust level to practice level, but promised extra guidance.

Mr Ricketts said the framework, which compels councils and PCTs to do compulsory joint needs assessments but is mostly voluntary, was as vital as the 18-week target.

He admitted it could result in varying levels of service. 'It's about targeting those areas with most need - if it doesn't match up with the next PCT, so what?' he said.

The framework is out for consultation, and will be released in the summer.