One of the key problems identified by health professionals in the lead up to commissioning power being handed over to GPs has been timeframe, rather than enthusiasm for reform.
The NHS Confederation voiced its concern today, saying that ministers need to do more to show how NHS reforms will be pushed through without damaging patient care.
The radical shake-up will place GPs in England at the heart of commissioning services by 2013 and responsible for around £80bn of health service budget.
Nigel Edwards, acting chief executive of the confederation, said the government had failed to explain how it will manage reform – the main source of anxiety – or protect accountability in a new system.
Although Edwards said he backed reforms, which will see primary care trusts and strategic health authorities abolished, but warned that health professionals needed a better plan of how it would be managed. He said 2011 may yet prove to be "the toughest year" in NHS history.
"If the issues are not fully recognised, they will be dealt with poorly and patients will be the losers," Edwards said.
"The NHS is going to have to get all hands to the pumps and it will need all the help it can get. We need policy-makers to fully understand the pressures, to act to mitigate the risks and to persuade those involved that we are on the right course.
"The mechanics of who does what to whom and who oversees it is done correctly will be central to making the new system work. It needs to be crystal clear but it remains a grey area and is therefore one of the biggest risks to the reforms working. Parliament will also have to grapple with the issue of whether the reforms are powerful enough to achieve their goals.
Edwards added: "It is the transition that is causing greatest anxiety to the NHS. Regardless of the strengths and weaknesses of the government's plans, we have to get there first. That will mean avoiding hazards such as financial problems and failings in patient care."
While Edwards said the confederation understood the need to make savings he also made a plea to government over social care funding, which he said must remain a priority as the NHS changes. "The tough questions cannot be ducked any longer," he said. "It will be a disaster if [care funding] gets put on the back burner once again. This is a moment for the government to be brave."
John Healey, the shadow health secretary, said confederations concerns were a "wake up warning" to the government from those who ran the NHS day-to-day.
But health minister Simon Burns said: "Reform is a necessity, not an option. The NHS must now rise to the challenge of implementing these reforms...rather than being micromanaged by politicians and civil servants."