Managers have been warned to expect a 'huge leadership challenge' in an operating framework devoted to implementing the next stage review.

The 2009-10 framework includes plans to turn a national target to halve MRSA levels across the NHS into a new minimum standard for individual organisations, assessed by the Care Quality Commission.

One of next year's main challenges will be to go "further and deeper" in making efficiencies in order to achieve "very substantial efficiency savings" by 2010-11. This will involve shared services, collaborative procurement, better use of assets and frontline incentives, it states.

Despite the wide range of objectives, managers are pleased there are few new demands. NHS Confederation policy director Nigel Edwards said: "People have an opportunity to get on with things, which will be welcomed." However, he also said that while the MRSA standard would be good for patients, it "may come as a struggle for some trusts".

He added: "This isn't technically a new target but it's an imaginative reinvention. The NHS hit its target but there are trusts that still have very big MRSA numbers."

Local priorities

The framework sets out areas expected to be treated as local priorities by primary care trusts, including reductions in mixed-sex accommodation. But PCT Network director David Stout said there was "no point in setting arbitrary deadlines that can't be met" on mixed-sex wards.

PCTs have also been told they need to improve GP access, increase public awareness of choice and use contracts to improve service quality.

Along with strategic health authorities, they must prepare for a legal right to choice to be in place as early as next April. And a "pricing framework" for community services will be published later this month.

NHS chief executive David Nicholson said he had listened to managers in avoiding new targets: "That is exactly what people said they wanted and it's what we [have] delivered."