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swathe of changes to bill announced

Prime Minister David Cameron has unveiled a swathe of changes to the government´s plans to reform the NHS - bowing to pressure from health service professionals, patients and his Liberal Democrat coalition colleagues.

Mr Cameron relaunched the controversial Health and Social Care Bill at a press conference at Guy´s Hospital in London yesterday backed by Nick Clegg his deputy and Health Secretary Andrew Lansley. In a significant change in focus away from competition, the Prime Minister said the government had listened to fears about increased competition and more powers for GPs and would now slow the pace of change.

Key changes to the bill include:

* the health secretary will continue to be legally responsible for promoting a comprehensive health service

* relaxation of the April 2013 deadline for clinical commissioning groups - previously known as GP consortia - to take over budgets from PCTs.

* PCTs will still cease to exist in 2013 and local arms of the NHS Commissioning Board will commission on behalf on commissioning groups that are not ready to take over

* Commissioning groups will not be able to delegate their statutory responsibility for commissioning to private companies or contractors

* Governing bodies of commissioning groups will have to meet in public and publish their minutes * Changes to the quality premium for commissioning groups to make clear its purpose is to reward effective commissioning

* Health and Wellbeing groups will have a new duty to involve users and the public and in promoting joint commissioning and integrated provision between health, public health and social care

* greater input into commissioning groups´ decisions from other health professionals such as hospital consultants and nurses

* a dilution of the focus on competition with Monitor´s role to protecting and promoting patients´interests, additional safeguards against privatisation, price competition and "cherry-picking" * commissioning groups will have to "promote research"

* commissioning groups will have to include "NHS" in their names

Announcement of the changes followed weeks of political wrangling as the Lib Dem´s opposition to key elements of the reforms toughened following a poor showing in the May local elections. It also followed Monday´s publication of a highly critical report from the NHS Future forum led by former RCGP chair Professor Steve Field. The expert forum gave its recommendations on the changes needed to the health bill following a 10-week 'listening exercise'.

In response to the Future Forum´s report, Dr Johnny Marshall, NAPC chairman said: ‘In this period of financial restraint, it is critical that we urgently begin to move on to find ways of improving the variability in the provision of healthcare and its outcomes and deliver the very best care for patients and the very best value for taxpayers. As the Future Forum Report stressed, resisting change and progress is not an option, if we wish to see an NHS that is free to all its population at the point of delivery, when the demographic time bomb explodes around 2015.' The NHS Alliance urged the government to move swiftly following the Future Forum report. Michael Sobanja, chief executive of the Alliance, said: ‘The report's findings and recommendations show that the direction of travel is right. We are pleased to see that many of Alliance's views have been reflected on the report. In the current financial climate, we cannot afford to delay or miss this urgent opportunity.' Dr Clare Gerada, RCGP chair expressed concern that GPs would no longer be at the heart of the new system: ‘We still have a number of outstanding concerns about the potential risks and unexpected consequences of the proposals. We need the government to reassure us that GPs will be given the freedom and autonomy to lead the decision-making and design of future integrated health systems drawing on the support of other health, social care and third sector services.' Dr Hamish Meldrum, BMA chair said: ‘The Future Forum's recommendations address many of the BMA's key concerns, to a greater or lesser extent. We are hopeful that our "missing" concerns, such as the excessive power of the NHS Commissioning Board over consortia and the so-called "quality premium" will be addressed as more detail emerges.' Dr Jennifer Dixon, director of the Nuffield Trust said: ‘The Forum has done a good job of helping to clarify and suggest ways that the best intentions of the original legislation can be built upon, whether in terms of creating more patient choice or establishing the conditions for less political interference and more clinical leadership. As a set of principles, the recommendations provide a sound basis for consensus.'Turning Point's chief executive Lord Victor Adebowale - a member of the Future Forum - said: 'I remain concerned about addressing the needs of those with complex needs. This is the litmus test for a modern NHS and saves money. Accountable, transparent, community commissioning remains key to achieving better outcomes for this group.'

David Cameron and Andrew Lansley at listening exercise event