Rethink NHS overhaul, review says

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Media captionProfessor Steve Field, GP who led the forum: 'Competition isn't the be all and end all'

The health plans for England need a major re-write to ensure the best interests of patients are protected, an independent review says.

The NHS Future Forum, which carried out a two-month consultation, called for the overhaul to happen more gradually.

The panel of experts also said it wanted to see a greater balance between competition and co-operation among NHS hospitals, charities and private firms.

Ministers are expected to respond to the recommendations on Tuesday.

They hope that by acting quickly they will be able to get their NHS reform programme back on track in weeks.

In April the government took the unprecedented move of halting the parliamentary progress of the Health and Social Care Bill underpinning the changes amid mounting criticism from academics, health unions and MPs.

GP power

Ministers had originally wanted to hand GPs control of much of the NHS budget, while opening up the health service to greater competition.

But while GPs will remain in the driving seat, they should consult with other professionals, the forum said.

To ensure this happens, clinical senates made up of a variety of different experts including hospital doctors and nurses should be created to oversee the new system, the forum's report said.

The focus on competition - perhaps the most controversial element on the plans - also needed to be "significantly diluted", according to the forum.

Originally, the regulator was to have a primary duty to promote competition, but that should be dropped along with the term "economic regulator", which the forum said made the NHS sound to much like the gas or electricity industry.

Instead, the regulator should focus on ensuring patients have choice to drive up standards. While competition has a role to play in this so does collaboration and integration, the forum said.

The report also said consortia should only take on their responsibilities when they were ready.

Originally a deadline of 2013 was set, but the panel said the national board could step in in those areas that were struggling.

Patients should also to be given a new "right to challenge" to put pressure on the NHS to keep standards up - although how this will work in practice was not set out in detail.

Professor Steve Field, the former head of the Royal College of GPs who led the forum, said while the principle of putting doctors in charge was well supported, he had heard "genuine and deep-seated concerns" from many.

"If the substantial changes we propose are accepted by government then I think the resulting framework will place the NHS in a strong position."

The recommendations have been welcomed by many involved in the health service.

Sir Richard Thompson, president of the Royal College of Physicians, said the changes to competition were a "step in the right direction".

Dr Hamish Meldrum, chairman of British Medical Association, said the government's approach during the listening exercise had been "refreshing", but this needed to be maintained in the coming months.

"Obviously, the critical factor is now how the government responds."

Professor Chris Ham, chief executive of the King's Fund think tank, agreed.

"The government must now move quickly to endorse today's report, put an end to the disagreements that have dominated recent months and provide the direction and stability the NHS desperately needs to navigate the challenging times ahead."

But Dave Prentis, general secretary of Unison, did express concerns.

He said: "The forum's changes may airbrush some of the flaws, but no amount of fiddling around around the edges is good enough when the future of the NHS is at stake."

Government mood

Despite the formal announcement by government not being made until Tuesday, Prime Minister David Cameron has already accepted concessions will be made.

Last week he set out a series of areas he was planning to give way on. These chime closely with what the forum has now proposed.

Speaking ahead of the full government response, Health Secretary Andrew Lansley said the group had been an "invaluable source of expert advice".

The political fall-out within the coalition is also being closely scrutinised.

Speaking to Lib Dem MPs, Deputy Prime Minister Nick Clegg said his party's demands for changes to the planned reforms had been "handsomely met".

But backbench Tories have been vocal in expressing concerns in case the reforms are being watered down too much.

Labour has indicated it will be voting against the bill whatever the changes are.

Shadow health secretary John Healey said: "My fear is that we'll hear the prime minister claim these are substantial and significant changes, but the long-term ideological plan to turn the NHS into a market, to open up all parts of the NHS to private companies, will remain."

Nonetheless, the BBC understands that ministers are hopeful the NHS Future Forum report and the government response will allow them to press ahead almost immediately with the programme.

Officials are working on the basis that amendments could be made to the bill within weeks, allowing the government to kick-start the parliamentary process before the summer

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