Peers have voted through the Health and Social Care Bill, establishing GP commissioning bodies and opening up the NHS to more competition.
Ministers will be relieved that the health bill is now almost certain to make it onto the statute books, as it proceeds through its second reading to committee stage before a third reading and then royal assent.
Opponents of the legislation, which include the BMA and the RCGP, hoped that peers would back motions by former GP Lord Rea and another doctor Lord Owen, scrapping the health bill or sending it to a special committee respectively.
A significant majority of peers rejected a motion denying the health bill a second reading and effectively killing it off.
It was put forward by Lord Rea who said that the health bill must be ‘sent back to the drawing board, so that the NHS can get back to work without a Sword of Damocles hanging over it'. Lord Rea's amendment failed by 354 to 220 votes.
The House of Lords then rejected former hospital doctor Lord David Owen's motion to establish a special committee of peers to examine the proposals in greater depth by 262 votes to 330.
Health minister Lord Howe had said that establishing such a committee would potentially create such a delay that the health bill would have missed royal assent in April, effectively killing off the bill.
Lord Howe argued that the floor of the House of Lords was the appropriate place for a proper examination of the bill as proved by the fact that 100 peers were speaking on the controversial legislation.
Lord Owen had said the select committee route would be better than discussion on the floor of the house because ‘there are a number of amendments that need to be made to the secretary of state's powers, and they need to be connected'.
He added: ‘I agree that there should not be delay. But a matter of a week or two is a bit rich from a Government that already "paused" the bill and had a "listening exercise"'.
Dr Hamish Meldrum, Chairman of BMA Council, said: 'It remains the BMA position that the Health and Social Care Bill should be withdrawn, or if not that it should be substantially amended, and we will continue to raise our concerns at every available opportunity as the Bill progresses through the House of Lords.'
'The BMA continues to have many areas of concern, including the need for assurance that increasing patients' choice of provider for specific elements of their care won't be given priority over the development of integrated services and fair access.'
'We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services. In addition, we continue to have significant concerns over the arrangements for public health and education and training and we will be looking to see improvements made in these areas too.'