GPs and practice staff could find themselves sidelined in the rush to introduce planned NHS reforms, critics have warned.

The proposed reforms were tabled in Parliament yesterday, receiving mixed reactions amid concerns about a ministerial “power grab” and the role of private companies. The Health and Care Bill enables the creation of integrated care systems to replace GP-led clinical care groups, ending 30 years of the so-called internal market and also reversing recent outsourcing rules. There are also some promised measures to tackle junk food promotion and some minor reforms to social services legislation. But its proposals for procurement alarmed many campaigners, amid concerns that partnerships with the private sector might lead to waste of public money similar to that seen in some of the pandemic responses over the last year.

Critics also questioned the extent to which Health Secretary Sajid Javid will acquire new powers over the service, limiting the independence of NHS England. There was also concern that the Bill does not deal with NHS workforce shortages. There were concerns about the timing of the legislation and the British Medical Association questioned whether it would deter doctors from taking part in changes.

Mr Javid himself has been reported as seeking to delay the Bill amid concern from MPs that they could now be held responsible for unpopular local service closures. Mr Javid said yesterday: “The astonishing response of our health and care services to the COVID-19 pandemic has hit fast forward on some of the bold changes the NHS set out to deliver in its Long Term Plan and shone the spotlight on other areas that require change to achieve better care for our communities. To help meet demand, build a better health service and bust the backlog, we need to back the NHS, as it celebrates its 73rd birthday this week, and embed lessons learned from the pandemic. This will support our health and care services to be more integrated and innovative so the NHS can deliver for people in the decades to come.”

British Medical Association deputy chair Dr David Wrigley said: “Whilst in the midst of a pandemic and facing the largest backlog on record, the BMA has consistently raised concerns whether now is the right time to introduce wholesale reforms. The BMA has long supported collaboration and called for the removal of enforced competition through Section 75, which the bill would achieve. However, the Government has to go further if the NHS is going to be truly protected from unnecessary and costly private sector involvement. The most effective way of doing that is to make the NHS the default option for NHS contracts and to only tender competitively where this is not possible. This is also vital to avoid the awarding of contracts without scrutiny to private providers at huge expense to the taxpayer, as was seen with the procurement of PPE and Test and Trace during the pandemic.

“The BMA has long supported collaboration and as such has been clear that it is vital that there is clinical leadership and representation embedded at every level of Integrated Care Systems, including formalised roles for representative doctors working in primary care, secondary care and public health, to effectively achieve this. Introducing the Bill now, gives rise to concerns that there may not be enough time for clinicians to engage effectively – it is after all clinicians who know their communities and where the greatest barriers to integration lie.”

Dr Jennifer Dixon, chief executive of the Health Foundation, said: “To ease the Bill’s passing, the new Secretary of State for Health should now drop the contentious proposals to give his role more power over the day-to-day running of the NHS. He should add his own stamp to the Bill by adding simple but much needed provisions to improve workforce planning across the NHS and social care. This would help to ensure that staffing shortages in the NHS, which are slowing progress on the backlog, are addressed.”

King’s Fund chief executive Richard Murray said: “These are important reforms that could be undermined by controversial plans for greater ministerial interference in the day-to-day running of the NHS. Chronic staff shortages have dogged services for years. Yet the measures in this Bill to address workforce issues are wholly inadequate. We are calling for a new duty to publish regular workforce supply-and-demand projections to highlight where action is needed to avert a deepening of the workforce crisis.”

Dr John Lister, secretary of Keep Our NHS Public, said: “The Bill won’t stop privatisation, but could increase it, as well as tightening limits on spending, putting private companies on boards (as has already happened in Bath & Swindon), and effectively ending any local control and accountability, with just 42 Integrated Care Systems taking charge.”