A group of doctors has reacted angrily to radical proposals in the NHS bill published today, calling it an "disastrous experiment" with British healthcare that didn't reflect the "enduring values of the NHS".
The draft legislation, drawn up by the health secretary Andrew Lansley, is one of the most radical structural shake-ups of the NHS and includes the scrapping of primary care trusts, more responsibility for local authorities, allowing healthcare providers to compete on price, and GP's taking on the role of commissioning services.
The group of 150 doctors said, in a letter sent to The Times, that the "wholesale re-engineering of the NHS and the destruction of PCTs" was expensive and unnecessary and said the bill represented an "irreversible step" towards privatisation.
"As doctors we believe the health bill represents an irreversible step towards the dismantling and privatisation of large parts of the NHS. The health secretary is already implementing its proposals even though the bill is not yet law. MPs and peers must use this opportunity to avert a disastrous experiment with the nation's healthcare."
The London borough of Bexley is among the first wave of pilot areas where GP's have begun to take on commissioning responsibilities in long-term conditions such as diabetes and heart disease.
The signatories, which include Dr Richard Horton, editor of The Lancet, and professor Wendy Savage, said the great majority of doctors, both GP and hospital, opposed the bill as well as experts in the King's Fund, organisations including the Royal College of Nursing and the Community Practitioners and Health Visitors' Association, the NHS Confederation, the Patients Association, as well as the trade unions, Unison and Unite.
"If the goal is to involve GPs in commissioning it should be noted that some GPs are already working successfully with PCTs. The government's fulsome claims to be engaging GPs cannot conceal that this "policy" is a cloak for hospital closures, mergers and privatisation.
"The use of Monitor to compel commercial competition will make hospitals subject to EU competition law and threaten the end of an equitable service. There is much evidence that price competition in a market worsens healthcare and no evidence that it improves it."
Although many of the proposals set out in the bill, such as the scrapping of PCTs, were expected, after a government white paper in June, there were still voices of concern over the size and scope of reform. Doctors have been particularly vocal over the issue of GP commissioning.
If passed the bill will see the establishment of Public Health England, a new quango, that will share much of the responsibilty for public health with local authorities and GP commissioners in the wake of the demise of primary care trusts and strategic health authorities. The new body would also take on the work of bodies such as the Health Protection Agency.
According to a report in the Guardian, No 10 was so taken by surprise over the health secretary Andrew Lansley's proposals for the NHS that prime minister David Cameron ordered a strengthening of his own policy unit to be better prepared in future and sparking a denial from Lansley that he had sprung a surprise.
Although the Conservatives had promised an end to "reorganisations that aim for change, but instead bring chaos" in 2009, the proposed NHS reforms have been called some of the toughest the service has ever faced.
Lansley, who has said he had made no bones over reorganisation of NHS management, said he had been clear from the start over redesigning services.
"We were very clear before the election that we were going to transfer the responsibility for planning, designing and commissioning services to GP-led consortia," he said.
But one senior Liberal Democrat said: "There is a real risk introducing this structure at a time when the years of financial plenty are over. The government is seeking £20bn of efficiency savings over four years, and there is a real danger we will end with a car crash of reorganisation and budgetary crisis in which we, the coalition, get the blame."
Plans to open up the market of health providers has also been met with criticism. Sir David Nicholson, the NHS's chief executive, told the commons' health select committee yesterday that allowing providers to compete on price could be "very dangerous".
He told the Health Service Journal that he would consider "direct management" of consortia that failed to reach the appropriate standard by April 2013.
Ten questions to ask about the bill produced by Chris Ham from the Kings Fund can be found here.