Doctors have called for the government to include a clause prioritising fair access for all as part of its NHS reforms.
However their primary goal is still for the Health and Social Care Bill to be scrapped altogether.
As a result of the Bill reaching its committee stage in the House of Lords, the British Medical Association (BMA), which represents doctors of all classes, has published further changes it wants to see made to the legislation to mitigate its damage to the health service.
Despite significant opposition to the Bill in the Lords, it is unlikely the chamber will decide to block the legislation altogether and may only choose to alter certain elements.
In a briefing paper for peers, the BMA sets out 11 areas of concern, with four most urgent points being:
• the Secretary of State to retain ultimate responsibility for the provision of comprehensive health services; (an amendment tabled by Lord Mackay of Clashfern seeks to achieve this and the BMA is supportive of its intention),
• competition and cherry-picking: the BMA wants to see an amendment making it explicit that increasing patient choice will not be given greater priority than ensuring fair access for all; it also wants to see further safeguards so providers cannot choose to provide only more profitable services,
• incentives for commissioning: the BMA continues to have serious concerns about actual and perceived conflicts of interest as a result of linking financial incentives to the performance of Clinical Commissioning Groups (CCGs),
• overly restrictive powers over CCGs: the BMA wants to see amendments and assurances that the government's pledged devolution of power is genuine, so that commissioners will truly have the freedom to commission the most appropriate services with, and for, their patients.
Dr Hamish Meldrum, chairman of BMA Council, said the BMA's preferred option is for the Health and Social Care Bill to be withdrawn.
"However, during this stage of the parliamentary process, there is scope for further significant change to be made, so we have today set out the areas where we believe there still need to be amendments.
"We hope the Lords will agree with us and change the proposed legislation, limiting the damage this Bill could do to the NHS.
"Because so much of the detail won't appear on the face of the Bill and will instead be left to secondary legislation and guidance, it is essential to have firm assurances now about the government's implementation plans, for example, we continue to have serious concerns about the ethics of the current proposal to incentivise commissioners," he added.
Other areas where the BMA is seeking amendments relate to public health; the private patient income cap; the foundation trust failure regime; increasing bureaucracy and complexity, and information and confidentiality.
