Mike Waites: The Minister's fresh prescription for the NHS could turn into a nightmare

He had spent nearly seven years shadowing health in opposition, giving him an unparalleled knowledge of how the health service works, what does not work and the potential solutions as the Conservatives sought to convince the electorate the NHS was "safe in their hands".

And yet it took him fewer than seven weeks to draw up reform plans which are setting the NHS on course for disaster.

Doctors, nurses, health service unions and independent experts have attacked proposals to give GPs control of around 80bn in NHS spending – and particularly their timing ahead of unprecedented health service retrenchment.

Now the new Royal College of General Practitioners (RCGP) chairman, Clare Gerada, has warned GPs may even face patient revolts over controversial decisions they will come to make.

Politicians have shown a compulsion to intervene and "re-disorganise" the NHS throughout its 62-year history, partly mindful of Aneurin Bevan's words about the sound of a hospital bedpan landing on the floor in Tredegar being heard in the corridors of Whitehall.

Labour tried it three times between 1997 and 2010 – although when it left office the general shape of the health service was roughly the same as when it took over.

The key difference Labour made was never-before-seen investment. Much of the extra billions went on higher staff pay, while desperately-needed new buildings were paid for in private sector deals that will be a drain on the public purse for decades.

Nevertheless, no-one waits today for two years, or even more, for a life-saving heart operation or lies on a trolley for days on end in hospital corridors. Treatment of cancer and heart disease in particular has significantly improved. In Yorkshire, there was a fall of 25 per cent in fatalities from strokes last year, saving 750 lives.

Surveys show as many as four out of every five NHS patients say they are happy with services. It remains doubtful that customers of banks, power and telecom companies or even local tradesmen would give similarly high ratings.

Now the years of NHS plenty are over. Despite Ministers' claims of real-terms budget increases, it faces heavy cuts. Already, health chiefs are targeting 20bn in efficiency savings.

According to popular belief, huge cuts could be achieved by removing vast swathes of NHS bureaucracy but even if every manager was shown the door, it would not save nearly enough. Neither would it be practical – for no organisation can be managerless.

In practice, hospitals, which swallow the most revenue, will bear the brunt of cuts. Smaller district hospitals will lose services. Already Accident and Emergency units in some parts of the country have shut. Patients requiring hospital care will spend less time there as services are developed in the community.

All this will be done as the population lives longer and illnesses of old age will see demand increase. Tough decisions will be needed about what to provide and where, despite public outrage as much-cherished services are axed.

Mr Lansley has decided that GPs, the gatekeepers of NHS care, should make those decisions.

The principles behind this are logical. The actions of family doctors are a key driver of the way the NHS works in initial diagnosis, referral for tests or treatment and continuing care in the community.

The Health Secretary, who has spent much of the last seven years listening to doctors complaining that Government targets mean they are not able to treat people according to how they see fit, will give them the resources to do that – or as much as the country can afford, which is not the same thing.

But there are a number of problems with the approach which will see GPs replace existing primary care trusts (PCTs) to set up consortia across the country to spend 80bn of taxpayers' cash.

Tough decisions will be needed about services but will GPs want to make them, given the inevitable public outcry?

Clare Gerada, from the RCGP, has warned that doctors could even face demonstrations outside their surgeries as they wrestle with rationing services.

She also points out that the changes will end the NHS as a national, unified service, since each GP consortia would decide which treatment to provide locally, leading to different parts of the UK receiving different services.

Ministers are ending the National Institute for Clinical Excellence's role in preventing poor value treatments being used on the NHS. Instead decisions will be left to purse-holding GPs. Dr Gerada suggests that making doctors "the new rationers" of care could diminish patient trust in their decisions.

But the biggest question mark over the plans is their timing.

NHS managers, many of whom face redundancy, have been subjected to heavy criticism from Mr Lansley despite their vital role keeping a grip on NHS finances until GPs take over in 2013.

Already some PCTs – among them North Yorkshire's – have plunged into the red, forcing the Health Secretary to recently deny that PCTs were "in meltdown" due to his reform plans in response to concerns from his own party's MPs.

The stability of NHS finances is already causing alarm at the Treasury, amid estimates the shake-up itself will cost 3bn. John Healey, the Shadow health secretary, has accused Mr Lansley of running a "rogue department", while former Tory Health Secretary Stephen Dorrell, now chairman of the MPs' health select committee, has given lukewarm backing to the plans and sees the financial problems facing the NHS as its biggest priority.

Even NHS chief executive Sir David Nicholson is urging caution as he attempts to hold the service together.

History suggests NHS finances can unravel quickly, destabilising services. Waiting times rise, services are axed, patient care is damaged.

Mr Lansley has a vision for the NHS but it could quickly become a nightmare given the financial plight of the health service and the upheaval involved.

He and David Cameron must urgently think again. Otherwise, the impact on millions of patients of reforms, which are irrelevant and wrong for these times, will be disastrous.

Mike Waites is the Yorkshire Post's health correspondent.