GPs have been given the green light to press ahead with commissioning groups after major changes were announced to plans for reform of the NHS.
Health Secretary Andrew Lansley denied that a listening exercise conducted by the Government over the Health and Social Care Bill represented a "tearing up" of plans to modernise the NHS.
He told GPs at a conference in west London there was now "nothing" to stop them from pressing ahead with clinical commissioning groups following major changes to the legislation announced yesterday.
"Let me now be absolutely clear, there is nothing to stop you now from pressing ahead," he said.
"Strategic health authorities and primary care trusts will cease to exist in April 2013. By then all general practices in England will be members of either a fully or a partly-authorised clinical commissioning group or one that is not yet authorised but nonetheless has been established.
"We cannot have gaps in coverage. We must not have a two-tier system, so we will establish clinical commissioning groups covering all of England by that date of April 2013."
Mr Lansley said the pause in the passage of the Bill had been right to get it as "right as we possibly can".
"While delay, I know, can be frustrating, especially as we have all been putting plans in place, the pause was right in order to get things right to make the Bill as right as we possibly can," he said.
Mr Lansley insisted that the timetable for setting up commissioning groups would be more flexible and no-one would be forced to take on new responsibilities before they were ready.
"April 2013 will not be a 'drop dead' date for the new commissioners," he said.
The big changes announced to the plans for reform came after the Government accepted key recommendations of a panel of health experts.
The changes include nurses and consultants to be included on the boards of new GP groups responsible for commissioning healthcare services.
There will also be stronger safeguards against a "market free-for-all", with the regulator Monitor required to protect patient interests and not to promote competition as an end in itself.
Other changes include additional safeguards against privatisation and to prevent private companies "cherry-picking" profitable NHS business.
Mr Lansley told the conference that every commissioning group would have a governing body which will ensure all decisions are made in an "open and transparent" way.
He said this body would need to include at least one registered nurse and one secondary care specialist doctor.
But he told the conference that, to avoid any potential conflict of interest, neither should be employed by a local health provider.
The decision not to allow either a nurse or a hospital doctor employed by a local health provider was challenged in questions later by two GPs.
Dr Roger Pinnock, chairman of Ashford Locality Commissioning Group, said: "A consultant to sit on the commissioning group not from the local provider - we are in East Kent, we are effectively a peninsula, we have sea on three sides of us... where on earth is this consultant going to come from?"
Dr Chris Trzcinski, joint chairman of the West Leicestershire GP Commissioning Consortium, and a GP in Markfield, Leics, told Mr Lansley: "The people who want to be involved are the local consultants and you are going to end up with people who aren't that involved in the local health service... people from outside the area who won't have that particular interest in the local health service or people who aren't directly involved."
Mr Lansley said: "We did start from a position of really literally not prescribing to you how you go about this task but we are taking people with us and many of your hospital consultant colleagues felt that they were being excluded.
"What we need to do is to demonstrate by this range of mechanisms that is far from the case."Reuse content