The chief executives of the three major health regulators have been summoned by the prime minister to discuss the pressures the service is likely to come under this winter, HSJ has discovered.

David Behan of the Care Quality Commission, David Flory of the NHS Trust Development Authority and David Bennett of Monitor met David Cameron earlier this month. This comes at a time many acute sector leaders have complained of a growing culture of micro-management on the issue.

The three chief executives already have weekly meetings with health secretary Jeremy Hunt. HSJ has been told these are now dominated by winter performance planning, particularly relating to accident and emergency departments.

Managers of A&E units have complained the resulting level of micro-management being ordered by the Trust Development Authority was excessive and “distracting”.

One hospital chief operating officer told HSJ: “They are digging into a level of detail that is extraordinary − they are basically performance managing every aspect of every conversation [with other parts of the health economy]. There are multiple daily phone calls, multiple 40 minute conference calls and complex agendas sent late in the evening.”

One director of an NHS England local area team told HSJ the regularity and detail of returns required on winter plans and A&E performance by the organisation’s headquarters was more intense than ever before.

He said it was a result of the government demanding regular and detailed reports from NHS England nationally, even though “it’s an approach that’s completely at odds with the spirit of the [government’s] reforms”, which were intended to separate day to day management of the service from politicians.

NHS England publishes weekly A&E data measuring performance at type 1 A&E units, which deal with the most serious cases, alongside data covering attendances at urgent care centres and walk-in centres.

The national target is for 95 per cent of patients to be admitted or discharged within four hours. The English hospital sector’s type 1 units have collectively not met the target since mid July. The national figure for the week ending 20 October was 93.3 per cent and 78 of 140 trusts missed the target, up from 72 in the previous week.

Last winter dozens of trusts breached the A&E waiting times target, with problems continuing late into April. There were significant numbers of “trolley waits”, in which the gap between a decision to admit and admission was more than 12 hours.

In September Mr Hunt announced a £500m fund to support health economies over two years that Monitor and the Trust Development Authority had identified as being at highest risk of failure in A&E.

Both the Department of Health’s vulnerable older people’s strategy and NHS England’s review of urgent and emergency care are expected this month.