Many NHS targets are to be abolished, according to the revised NHS Operating Framework for England, including those relating to access to primary care.

Unite/CPHVA professional officer Gavin Fergie stated: 'While targets may not suit all practitioners, there have to be national standards to aspire to, ensuring that the NHS is based on equality and equity rather than down to postcode. This is another example of the deconstruction of our NHS. Our NHS feels under threat. Efficiency is a term easily used but rarely understood by politicians in relation to the healthcare needs of a family, and we hope to meet with the government to discuss and ensure that they are fully aware of the concerns of our members.'

The targets will be replaced by quality standards, comprising statements that describe what high-quality care should be for a given condition. The National Institute for Health and Clinical Excellence has developed three so far, on stroke, dementia and blood clots.

The revised operating framework also confirms that the government will be continuing with the commissionerprovider split, and urges NHS organisations to make arrangements for this by April 2011.

Unite Health Sector lead officer for nursing Barrie Brown responded: 'This reflects the move from the NHS as preferred provider to "any willing provider" and will add momentum to the push to involve the private sector and third sector as providers of NHS health services.'

He added: 'Where services are transferred to other organisations to meet this deadline, this will mean short-term vertical integration with acute and mental health trusts which will create uncertainty for our members and potentially undermine the effectiveness of services provided. There is also the uncertainty of the longer term provider arrangements and the likelihood that our members will be working Ln non NHS organisations.'