Health Secretary Andrew Lansley has dismissed claims that support among doctors for his planned reforms of the NHSis dwindling. The changes are about giving doctors greater freedoms and responsibility, and "they are stepping up for it," he says.

He does acknowledge that going through a process of change can create anxiety and that some professionals are finding it difficult. "I meet doctors who are enthusiastic and those who are nervous," said Mr Lansley, speaking in an interview with the medical network

Nevertheless, he added: "my experience has been that [doctors] are stepping up for it because they want to deliver the better results for patients that they know they can." 

"I spent seven and a half years as shadow Secretary of State for Health and now as Secretary of State, and I've met people right across the country in the health service who have said to me, quite straightforwardly, 'if only they would listen to us, we know we could do it so much better.' The 'they' is now me, and I am listening," he said.

Quizzed on the findings of a recent Nuffield Trust/ poll, which reported that just 23% of GPs believe the proposed reforms will improve the level of care which they are already providing to their patients, and the opposition mounted to the Health Bill by the British Medical Association (BMA), Mr Lansley rejected suggestions that all this represented a  "a change in atmosphere" in support for his plans. Nor did he believe the attacks on his plans by unions necessarily represented the views of health professionals or the public.

"I don't think the simple fact that the trade unions might be having a bit of a go is in itself necessarily representative of the views of people across the country," he commented.

The government's core aim in reforming the NHS has always been that outcomes for patients in the UK should be "as least as good as anywhere in the world," and the purpose of the Health Bill is to ensure that structures are there to support that, he said.

Many of the changes could have been introduced without legislation, but the Bill is a support to this big picture, giving NHS staff the transparency and stability of knowing that it is all set out in primary legislation, he said.

Mr Lansley said that while he had been told that Primary Care Trust (PCT) commissioning is currently 70% about cost and volume, the emphasis must switch to quality and care pathways.  "We need a real big shift in responsibility to frontline commissioners, doctors, nurses and health professionals. We need to take out tiers of management and all the philosophy that has said the things you do, you have to put in tick boxes, We have to enable people to do the job they are very well-equipped and trained to do," he added.

Some GPs had expressed concerns to the poll about the new management skills they will need to acquire as commissioners, in terms of being able to assess the efficacy, safety and cost-efficiency of treatments, but Mr Lansley responded that what he is looking for from them is clinical leadership - "I don't regard this as the same thing as management," he said. Doctors will have management support, and the epidemiological and public health support which they will need to assess the needs of their local populations, he said.