The planned shake-up of the NHS, including transferring the central commissioning body of the service to GPs, has been defended by Health Secretary Andrew Lansley.
He said that GPs should manage resources so that the needs of patients can be met, and denied that the planned reforms were a gamble.
Mr Lansley told BBC Radio 4's Today programme: "You have to make a decision about whether you are going to do reform or not.
"What this is all about is delivering power into the hands of patients. Shared decision-making between patients and their clinicians is absolutely critical.
"We have to focus on outcomes not targets."
He said ex-prime minister Tony Blair had disclosed in his memoirs that he regretted not pushing harder for public services changes.
Asked if the shake-up was a high risk gamble, he replied: "I don't think it's a gamble. I think it would be a greater gamble not to reform."
He went on: "GPs in effect make the most important commissioning decisions already.
"GPs are already in a critical position in terms of commissioning. We need the management of care of patients and the management of resources to meet the needs of patients brought together in one body."
Copyright © Press Association 2010
Do you think Mr Lansley is taking a gamble on NHS reform? Your comments (terms and conditions apply):
"Yes, I think it is a big gamble and one that has many holes in and get the feeling this is more about making NHS private then it is better patient care. Constant change without allowing to perfect any one system means that we will remain in chaos longer and spend more money trying to get out of it. Why did they not put more money and effort into fundholding if GP commissioning is the way forward? Fundholding was GP commissioning. With so many GPs (3 out of 4) against the change alongside BMA and Unison it would seem prudent to reconsider unless of course this is all about setting up to fail" – Dean Thompson, London
"Yes I do, as a practice manager there is more to general practice than referrals and prescriptions what about governance, IT all the reimburstments for drugs buildings who's going to over see all that. I was around in the old fundholding days and we didn't save a penny but some GPs made a shed load of money out of the system" – Wendy Ribbands, Ilkley
"The real danger in my opinion is that his reforms will be undermined in its implementation unless the processes and mechanisms to achieve his objectives are in essence based upon equity, excellence and equality of opportunity for all, transparency, clarity, credibility, consistancy. Mr Lansley must have an in-built system of level playing field for all, leading to clear signals that quality and outcome will be encouraged rewarded. The experience over the last decade has been that those who can politic better as oppose to perform better, has been rewarded better, those who have spent more have got more. Excellence and value for money has been branded something other than excellence and value for money. Competition has therefore been thwarted. I understand Mr Lansley is shying away from the convergence of all contracts, GMS, PMS, APMS, and huge infrastructure disparities. Instead such disparities have been institutionalised. Unless processes are put in place to eradicate relative disadvantages, one cannot possibly expect the same standards of achievements from all; indeed one is prevented to participate in the maximisation of proformance and outcome simply because the dice is loaded against some" – Mohammad Rafiq, London