Norman Lamb: If we get this reform wrong, patients are going to suffer

The key is to shift from a perception of revolution to one of evolution

For all those who care passionately about the NHS, we have to recognise that change is necessary. With health costs rising in every country due, primarily, to an ageing population, doing nothing is not an option. We have to find ways of making the money go further. And there is scope to do this. Labour was right to massively increase NHS funding, but they created a centralised bureaucratic monster, which often leaves doctors, nurses and indeed good managers at a local level totally frustrated.

At the heart of the Government's reform package is a very important principle, which most health policy experts agree on. We have to empower GPs to develop services to help keep patients out of hospital and we must make them responsible for the money they spend. This can result in better care and reduced cost. My fear is that there is a real risk we could put that objective at risk if we get the reforms wrong.

The last time the NHS was re-organised in 2005/06, there was a serious loss of financial control. Patient services were cut – particularly in mental health – and public health priorities suffered. That was when extra money was flowing into the NHS. Now we are attempting a reorganisation in a tight timescale at the same time as trying to achieve a four per cent efficiency saving every year. Many of the new GP consortia will manage this challenge, but the concern is that others will not. The consequences would not be pretty.

So, what is the way forward? David Cameron and Nick Clegg did exactly the right thing in announcing a pause for reflection. This is the opportunity for the Government to get people back on board. The key is to shift from a perception of revolution to one of evolution. And the model is already there. With the Government's education reforms, schools can apply for academy status when they are ready. As schools demonstrate the benefits, others follow and so a momentum for reform is built up.

We should do the same in the NHS. GP consortia could apply when they are ready. We must, of course, address the concerns highlighted at the Liberal Democrat conference and the Health Select Committee about accountability and governance of those consortia. In those areas where consortia are not established, there must still be reform. The clusters of Primary Care Trusts which have been established could remain, with clinicians and patient representatives and democratic representation added to the board, and there could be a progressive devolution of responsibility to groups of GPs.

This approach would help to reassure many in the NHS but would still be true to the central policy objective of the Government. I am very strongly committed to this Coalition. I want it to succeed and to deliver effective reform of our public services.

The writer is a government whip and chief political adviser to the Deputy Prime Minister, Nick Clegg.