As Ministers prepare to publish the Health and Social Care Bill tomorrow (January 19), MPs, doctors and other health professionals have expressed concern over the speed and scale of the government’s NHS reforms.

The government’s plans are “potentially disastrous,” warns a letter signed by healthcare unions including the British Medical Association (BMA), published in The Times newspaper yesterday.

The unions say they are extremely concerned that the government is not heeding warnings about key elements of its proposals, including the encouragement of price competition and the scale and cost of the reform programme.

“There is clear evidence that price competition in healthcare is damaging. Research by economists at Imperial College shows that, following the introduction of competition in the NHS in the 1990s, under a system that allowed hospitals to negotiate prices, there was a fall in clinical quality,” says the letter, which is also signed by officers of the Royal College of Nursing (RCN), Unison, Unite the Union, the Royal College of Midwives (RCM) and the Chartered Society of Physiotherapy (CSP).

“With scarce resources there is a serious danger that the focus will be on cost, not quality,” they warn.

Moreover, the “sheer scale of the ambitious and costly reform programme and the pace of change,” at a time when the NHS is being tasked with making £20 billion of savings, “is extremely risky and potentially disastrous,” the signatories add.

Meantime, a group of influential MPs has said this morning that the government’s NHS White Paper proposal to abolish Primary Care Trusts (PCTs) and transfer commissioning responsibility to GP-led consortia was not foreshadowed in the coalition government’s programme and “came as a surprise to most observers.”

This “surprise” approach created uncertainty among commissioners and therefore increased the risks and costs associated with delivery of the challenge set by NHS chief executive Sir David Nicholson of making up to £20 billion in savings over the next four years, say the members of the Health Committee of the House of Commons, in their third report on NHS commissioning.

The MPs say they do not believe the government’s plan is the most efficient way of delivering its aims of improving care, increasing choice and reducing bureaucracy.

More effective commissioning is key if the NHS is to make the unprecedented efficiency gains needed to meet rising demand against the challenging financial context in which the Service now operates, and this will require the engagement of the entire clinical community, says the Committee.

“GPs have a major role as a catalyst for this process, but not as the ultimate arbiters of all commissioning decisions,” the MPs add.

“The value of effective and accountable healthcare commissioning has been discussed for 20 years. During that time the NHS has met the financial cost of a commissioning system, but has repeatedly failed to take full advantage of the opportunities which commissioning should create to improve the quality and value of the services provided,” said Health Committee chairman Stephen Dorrell, Conservative MP for Charnwood.

However, Prime Minister David Cameron has defended the government’s plans for the NHS and other public services. “We can't afford not to modernise” them, he said, in a speech given yesterday at the Royal Society of Arts in London.

“Every year we delay [is] another year our health outcomes lag behind the rest of Europe,” said Mr Cameron, adding: “if not now, then when? We should not put this off any longer.”

However, Dave Prentis, General Secretary of UNISON, the UK’s largest union, described the Prime Minister’s speech as “all spin and no substance.”

“The NHS is not safe in Tory hands. Lansley’s proposals are unnecessary, untried and will cost the taxpayer dear. They threaten the very founding principles of the NHS,” said Mr Prentis.