National and regional managers are in talks about putting performance targets on hold to cope with the increasing number of people contracting swine flu.

Setting aside or relaxing performance targets would allow primary care trusts and providers to make sure urgent cases are dealt with, for example by cancelling elective surgery and clinics.

NHS London public health director Simon Tanner said there was “a lot of discussion” among strategic health authority performance managers about when to do that.

He told HSJ: “Clearly what we are seeing is a different order of demand [from the seasonal norm] and GPs, nurses and others are putting in extra work.

“It is a great credit to our trusts and PCTs that they are getting on and treating ill patients, not spending time asking when they are going to be able to [set aside targets].

“However, my performance colleagues have this in mind at some point as we see [swine flu] develop.”

Dr Tanner said there was no “timetable” yet but discussions had begun about how and when it should happen. He advised PCTs to refresh plans for prioritising cases, and for the impact of high profile incidents such as the death of London six-year-old Chloe Buckley. Public response to such incidents was likely to put services under particular pressure, he said.

New Department of Health guidance says decisions about prioritising services should be taken at a local and regional level. However, it is unclear whether the decision to set aside targets will be taken by the DH or SHAs.

The DH last week raised the prospect of staff and resources being moved between areas. It wants to aid this by mapping pressure on GP and hospital services in each PCT area.

However, such “mutual aid” staff sharing has so far only happened on a small scale and mainly within PCT areas.

One PCT public health director in an area with a high level of swine flu called for local decision making to be supported: “The people at the sharp end need the flexibility to respond in whatever ways they see fit to manage demand and make sure capacity is there.”

The West Midlands and London have had many more swine flu cases than the rest of the country. A spokeswoman for NHS West Midlands said setting aside performance targets was not yet being considered.

NHS South West public health director Gabriel Scally said less affected areas were dealing with a “steady stream” of cases, and preparing for an increase and the “big challenge” of a vaccination programme.