A briefing paper for peers debating the Health Bill in the House of Lords warns of rising bureaucracy, a lack of clarity, falling morale among clinicians and rising concerns over the stability of NHS services as the reforms take effect.

‘The reform package as a whole must be rethought,’ the briefing paper says. ‘It is not too late to think again. The government’s reform approach is adversely affecting the ability of the health service to deal with the real priority of improving quality in the face of a massive financial challenge.’

The BMA has hardened its stance on the Health Bill since a special representative meeting in March called for the Health Bill to be withdrawn or amended. The BMA shifted last month to opposing the Bill in its entirety.

BMA chairman Dr Hamish Meldrum said: 'There has been a growing level of unease about how the reforms are panning out – we hear repeated concerns from doctors about mounting chaos on the ground.'

The briefing says the government has failed to address concerns about issues including over-reliance on market forces to shape healthcare, changes to public health and medical education and the quality premium incentive payment for commissioners.

Enthusiasm in clinical commissioning groups (CCGs) is being hit by ‘vast amounts of guidance’ which are ‘constraining clinician-led commissioning in a ‘bureaucratic strait-jacket’.

The BMA warns that effort is being wasted because the reforms have been rushed, with newly formed CCGs and PCT clusters facing mergers and a lack of clarity over the future of existing staff.

‘There is a lack of a clearly articulated vision and little in the way of tested and co-ordinated plans for implementation,’ the briefing warns.

‘An increasingly massive amount of management and clinical time is being taken up with the process of reform, diverting attention from the pressing financial challenges facing the health service.’