In formal submissions to the NHS Future Forum, the British Medical Association (BMA) and the NHS Confederation have called for a major overhaul of the government's current health care reform proposals.

The Health and Social Care Bill should be withdrawn or at least undergo major changes, the BMA has told the Forum (the body leading the government's listening exercise on the reforms), warning that the legislation represents "an enormous risk" during a time of huge financial pressure for the NHS.

Over 70% of just under 1,000 BMA members who completed a feedback form on the Association's website this month said their attitude to the reforms was either "mostly or very unwelcoming" and, when asked which area of the reforms was potentially the most damaging, just over half identified the powers to be given to NHS economic regulator Monitor to promote competition.

The primary role of Monitor should be amended to the protection and promotion of high-quality, comprehensive integrated services, not the promotion of competition, says the BMA.

The Association's submission to the Future Forum also calls for a "more mature form of commissioning," based on clinical networks of specialties and primary care professionals working together across traditional boundaries alongside commissioning consortia, on which there should be an explicit duty to fully involve all relevant staff in commissioning.

The Secretary of State's duty to secure the provision of comprehensive healthcare services for the people of England should be reinstated and, in the meantime, the Secretary's powers over the NHS Commissioning Board (NHSCB) on appointments, further regulations and its mandate should be subject to explicit safeguards and transparency requirements, to avoid unnecessary political interference, says the BMA.

It is also calling for the NHSCB to be required to consult with consortia, where changes affect them, before making use of its powers to ensure an appropriate level of freedom. The independence of directors of public health should be explicitly protected by bringing together all public health staff under a single NHS agency, and patient consent should continue to be required for disclosure of confidential patient information, the Association adds.

The NHS Confederation's submission to the Future Forum says it strongly backs the idea of health service reform, noting that it is "not sustainable to increase indefinitely the proportion of national wealth spent on the NHS."

Moreover, the Confederation believes that some key aspects of the reforms have real merit, including the introduction of clinical commissioning, the empowerment of local government to improve health and wellbeing, and the focus on outcomes rather than inputs.

But, it says, the case for the breadth of the government's reforms "has yet to be clearly made." The proposed changes are not "sufficiently focused" on the problems facing the NHS, such as the financial squeeze, too much variability in the standards of care and the need to better integrate services for patients.

"We are absolutely in favour of reform because it is crystal clear that we cannot go on as we are," said Mike Farrar, the Confederation's new chief executive. "But we are determined to do more to ensure that the NHS concentrates its firepower on the issues that will make a difference to patients - getting better value for the taxpayer, treating people with dignity and closing the gaps between services." he added.

The Confederation says it is fully supportive of the use of competition and economic regulation where it can be shown that this delivers benefits to patients and the taxpayer. Competition and integration do not need to be contradictory, and the use of competition is vital to avoid the "capture" of patients by poor-quality service providers, it says.

Also, it says, a flexible timetable for the transition to new commissioning consortia will help minimise the risks associated with such significant reorganisation at a time when the NHS is charged with making £20 billion in savings. This could involve consortia taking a staggered approach to taking on full responsibilities, while alternative NHS bodies oversee commissioning in places where consortia have not yet been established, it suggests.