Opinion  

It is the 'to do' list issued to the people who have to make health care happen. The difference between white papers or speeches and the operating framework is the difference between an announcement that you are going to eat nothing but healthy food this year, and what actually appears in your shopping trolley.

So what are the highlights? Competition in primary care is still to be encouraged, by getting new provider organisations to bid for work alongside practices and PCT provider arms. PCTs must fully divide out their provider functions by April this year, and have service level agreements as robust as contracts with acute hospitals. This raises questions about which 'units of service' will be the contract currency used to quantify district nursing, health visiting or specialist services.

Access to GP services has to improve - the 'evenings and weekends' issue is not going away, and private providers of primary care services are beginning to come forward.

And, in spite of resounding silence on the issue at the end of 2007, the government is still experimenting with community foundation trusts, which could radically impact on other new provider organisations such as social enterprises, by providing an NHS alternative.

Altogether, the year ahead in primary care will see more of the pressure to meet patient expectations, to give them choice in their care, and improve on the quality issues that matter to them: timing, convenience, distance and 'customer relations'.

As nurses are the face, hands and heart of primary care, all of this will fall inevitably at their door over the coming months. A burden and a problem? Not with the kind of committed and enterprising nurses I know of. It's an opportunity to refocus on patients and their needs that could provide some interesting career options too.

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