The BMA has published its response to the listening exercise.

Their media release says that the legislation represents “an enormous risk” during a time of huge financial pressure for the NHS, noting that over 80 per cent of just under 1,000 BMA members who completed a feedback form on the BMA website in May said their attitude to the reforms was either mostly or very unwelcoming.

Just over half of respondents to this web survey identified the powers to be given to NHS economic regulator Monitor to promote competition as potentially the most damaging aspect of the reforms.

The BMA wants to see“a more mature form of commissioning”, based on clinical networks of specialists and primary care professionals working together across traditional boundaries, alongside commissioning consortia.

The BMA has also published new guidance putting forward examples of possible models for the governance of consortia. This suggests that, as a minimum, specialists should be involved in the design of patient pathways.

The key recommendations in the BMA’s response to the Future Forum are that:
* The primary role of the economic regulator, Monitor, should be amended to protecting and promoting high quality, comprehensive, integrated services, not promoting competition
* There should be an explicit duty on commissioning consortia to fully involve all relevant clinical staff in commissioning
* National and regional oversight of doctors’ education and training should be maintained, with UK-level workforce planning, and regional quality management continuing to be undertaken by deaneries (the BMA today also publishes a letter to the Future Forum from its Junior Doctors Committee)
* There should not be an artificially rigid timetable for all NHS trusts to achieve foundation status, as the current deadline of April 2014 could compromise patient safety
* The Secretary of State’s duty to secure the provision of comprehensive healthcare services for the people of England should be reinstated. Meanwhile his or her powers over the NHS Commissioning Board on appointments, further regulations and its mandate should be subject to explicit safeguards and transparency requirements to avoid unnecessary political interference
* The NHS Commissioning Board should 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
* Patient consent should continue to be required for disclosure of confidential patient information

Dr Hamish Meldrum, Chairman of Council at the BMA, said, “The message from doctors is clear and simple – the Bill must be changed significantly, if not withdrawn altogether, if the NHS is to continue to improve.

"We are right in the thick of the challenges the NHS faces, and while change is necessary, this major upheaval is not.

"We know that the NHS has to become more efficient, that chronic illness is growing, and that we need a step change in improvements in public health. Increasing and enforcing competition is not the answer – competition is not an end in itself. Instead, we are putting forward recommendations that aim to maximise the potential for positive change in the proposals, by genuinely giving more say to patients and to clinicians at the front line".