Managers have given this year's NHS operating framework a mixed response, welcoming its emphasis on improved commissioning, while expressing concern that the national priorities are too prescriptive.

Under the framework, primary care trusts will be expected to deliver on five key national targets over the next three years. At the same time, they can choose from a raft of indicators - or 'vital signs' - being developed by the Healthcare Commission when setting local priorities. Their performance against these indicators will be monitored annually.

Commenting on the framework, NHS Confederation chief executive Gill Morgan said: 'We agree that some things should be centrally prescribed and there is a need for national targets which are carefully constructed and flexible enough to drive improvement at a local level.

'The intention to move towards greater autonomy at a local level in the health service is welcome. However, rhetoric does not match reality. The framework is much more prescriptive than the five national priorities might initially suggest. NHS leaders believe there is already too much on both what the NHS should be doing and how.

'In this context, it is important that the proposed "raft of indicators" or "vital signs", though welcome in principle, do not turn into national targets for performance management.'

Her sentiments were echoed by King's Fund chief executive Niall Dickson, who also raised concern that PCTs would not have enough autonomy to deliver on local priorities given the extent of the national targets and requirements.

Mr Dickson said: 'The DoH undoubtedly faces a difficult balancing act between local freedoms and national responsibilities. And too many PCTs continue to look upwards towards government rather than out into their local communities.

'Now the strategic priorities for the NHS have been set for next year, PCTs must be left to get on with the task in hand with minimal central interference.'

Primary care trust network director David Stout said: 'Primary care trusts might control more of the NHS budget but the level of prescription means the space for discretion is limited.'

The five key priorities are:

  • improving cleanliness and reducing healthcare-associated infections;
  • 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.