A revised NHS operating framework is expected to immediately relax a number of Labour’s flagship targets - and pave the way for their subsequent abolition.
Senior NHS managers have been briefed that the revised operating framework for the current financial year - due to be published imminently - will effectively spell the end of the 48 hour GP access target, the 18 week referral to treatment target and the four hour accident and emergency waiting target.
HSJ understands health secretary Andrew Lansley plans to immediately relax the 18 week wait target for planned care by shifting the definition from 90 per cent of inpatients completed within the timeframe to one focused on the overall median waiting time experienced by all patients.
That would allow trusts to pass the revised target even if a significant minority of patients were treated much later than 18 weeks after referral.
HSJ has been told the Department of Health is exploring abolishing the target altogether.
A senior health service manager told HSJ: “This is trying to move towards being based on what local [GP] commissioners want - like faster waiting times for some [procedures] and slower for others.”
Plans to scrap the target altogether are complicated by its status as a “right” in the NHS constitution.
Even if that right was removed through legislation, there could be knock-on effects for patients’ right to choice of provider, which is defined with reference to the 18 week window.
The four hour accident and emergency target will be reduced from covering 98 per cent of patients to covering 95 per cent and is also destined for abolition.
A source told HSJ this was likely to be signalled by references in the operating framework to developing alternative measures of urgent care quality, “not just speed of access”, but also patient experience and better integration with primary care services.
The framework is also expected to announce the end of central collection of GP practice performance data against the 48 hour access target - which will effectively remove it as a target.
HSJ has been told primary care trusts will still be permitted to include the target as a specific contractual requirement with individual practices.
In an interview last week with HSJ’s partner website doctors.net.uk Mr Lansley confirmed his plans to extend GP commissioning would see consortia able to appoint PCTs, local authorities and private organisations to commission on their behalf.
He said: “They can get their commissioning support - they can create it themselves as consortia; they can go to independent organisations to provide it to them; they can ask the primary care trust to continue to do their commissioning for them if they wish; they can ask their local authority to help to do their commissioning for them.”