18 January 2011 Last updated at 20:20 ET

NHS bill to detail major overhaul in England

By Nick Triggle Health reporter, BBC News

The reforms were first set out in a white paper published last summer

The government is due to publish details of the biggest overhaul of the NHS in England since its creation, amid mounting criticism of the changes.

The Health and Social Care Bill, which will be laid before Parliament later, paves the way for GPs to get control of most of the NHS budget by 2013.

Unions warn the plans could undermine the health service, while MPs say they have taken the NHS by "surprise".

But the government argues the changes will improve care and accountability.

This will be the key message the Department of Health stresses as the bill is unveiled.

'Simple ambition'

After spending the past week defending the plans from attacks by unions, Health Secretary Andrew Lansley wants to stress the positives by detailing how he believes they will transform the NHS for the better.

GP view: How patients may benefit

Dr Ken Aswani, a GP in Waltham Forest, on the outskirts of London, is at the forefront of the changes. He is the lead doctor in one of the consortia which is piloting the changes for the government.

"We will be looking to build on what we have been doing in recent years. That means getting services out of hospital and into the community where they are more accessible."

One example of this that is already up and running is in dermatology care. There are now three clinics linked to GP centres across the borough where nurses, specially-trained GPs and hospital consultants work together to see people with skin problems.

Dr Aswani says: "It is much quicker now and patients do not have to travel as far. Feedback shows they really value this and these changes will allow us to do much more of this sort of thing."

Speaking ahead of the publication of the draft legislation, he said: "Our ambition is simple - to deliver care for patients which is the best of anywhere in the world on the NHS."

The reforms were first set out in a white paper published last summer and will lead to a radical overhaul of the health service.

Managers working for primary care trusts (PCTs) are currently responsible for planning and buying local services from hospital care to district nursing, but under the changes consortia of GPs will take on responsibility for this from 2013.

Pilots are already starting and once the process is complete, two tiers of management - PCTs and the 10 regional health authorities - will be scrapped.

The bill has been eagerly awaited by those in the NHS to see just how much power will be devolved to doctors, how they will be held accountable and what safeguards will be put in place.

'Extreme concerns'

In the lead up to its publication, fears were voiced by the NHS Confederation that hospitals could go bust as the plans include opening up the NHS to "any willing provider".

GP view: How patients could suffer

Dr Helena McKeown, a GP based in Wiltshire, describes herself as a sceptic. She believes one danger is that consortia may decide that some of the more marginal services are not a priority for funding. "Patients could see local bunion services go, for example, or orthodontics."

She also fears local hospitals could be hit as private sector providers look to win more NHS contracts. She gives the example of ophthalmology departments which rely on cataract operations as a vital source of income and an area for eye surgeons to gain experience for more complex work.

"Private firms will want the cataracts as they are less risky and less complex, but the consequence of that is the local hospital department could suffer.

"This could happen all across the hospital. I see it as like that game Jenga - if you pull too many blocks out the whole thing topples down."

Critics have also questioned whether GPs have the experience and skills to handle such huge budgets - they will have control of about 80% of the budget.

On Tuesday, the Commons health committee criticised the scale and speed of the reforms, saying the NHS had not been able to plan properly.

A host of unions, including the British Medical Association and Royal College of Nursing, have expressed their "extreme concerns" that greater commercial competition in the NHS would end up undermining care.

The government has responded by saying it is all part of a managed transition to devolve decision-marking closer to the patient so services are designed in a better way.

Ministers have also been quick to point out that despite the criticisms from unions, more than 140 groups of GPs have put themselves forward for the pilots, covering more than half the population of England.

The timing of the reforms has also been questioned. While the NHS will be getting small funding rises in the next four years, it is still being asked to making savings - £20bn by 2014.

Peter Carter, of the Royal College of Nursing, said: "This reform programme could come off the rails, as people concentrate on saving money rather than delivering quality care."