Dr Sarah Wollaston Conservative MP for Totnes, explains why the controversial NHS Bill should not be binned despite initial reservations about reform.

As someone who has been a critic of the Health and Social Care Bill, I have been asked if I will be joining the calls for it to be scrapped. The short answer is no and the reason is straightforward: I think it would now put clinical leadership of the NHS at risk if we did.

Some are worried that too many GPs will become managers rather than doctors if the reforms go ahead. In fact, the reverse is true. There has always been a shortage of GPs prepared to engage with the management and clinical leadership of the NHS beyond their surgery doors. Those who do are motivated by a real commitment to improve local services and across the country, doctors and nurses have started to redesign how they want to deliver healthcare through the emerging Clinical Commissioning Groups. To slam the door shut at this stage would risk losing that commitment and enthusiasm. As primary care trusts (PCTs) have been steadily dismantled, some feel that clinical leaders could simply head up the regional PCT clusters which are replacing them instead. My fear is that very few would want to do so and we could end up with no effective local clinical voice.

In South Devon there is a committed and effective team in place and I think it would be wrong to undermine the progress that they are making.

The Bill was changed very significantly after the unprecedented "pause" in legislation. The Future Forum and Health Select Committee forced a rethink on the role of competition and widened clinical involvement to include nurses and secondary care. The House of Lords' amendments will cement ongoing responsibility with the Secretary of State and protect the role and funding of research. The Bill improves local accountability and puts public health back within local authorities, where it needs to be to have the best chance of influencing and improving locally relevant public health issues. There are specific requirements to make it a duty for all the responsible bodies to report on health inequalities and Monitor will be encouraged to actively support integration of healthcare, putting this ahead of competition.

There is controversy about allowing up to 49 per cent of Foundation Trust income to come from private sources. The reality is that the vast majority of such trusts will not come remotely close to this, perhaps only centres of international excellence such as the Royal Marsden in London. For the majority it would at most be a small but important lifeline in improving such things as investment in technology for the benefit of all patients and it is wrong to assert that NHS patients will be neglected as a result. To talk about the privatisation of the NHS and imply that this will mean the end of free health care with an American-style system is alarmist. Having witnessed that system first hand, I know that is just not true. The greatest protection against inappropriate privatisation is the GP leaders who will be doing the commissioning. They are absolutely clear that they do not want to see the NHS fragmented or local services destabilised and that cannot happen unless they commission it. Why would they want to do so? Ten years from now patients will still be visiting their GPs and referred to the NHS hospital of their choice free of charge, based on need not ability to pay.

The real risk and one that I hope Health Secretary Andrew Lansley will address if he is listening to the emerging commissioning groups, is that GPs are feeling pressured into handing commissioning management support to the private sector. Many would like more time to get in-house support in place as they see the risk that private company involvement could undermine public confidence. Clinicians will always need high quality management support and it is time for politicians to change the language and appreciate the role that managers play and focus on cutting the bureaucracy that continues to suffocate the NHS.

There are real benefits in the Bill and it is easy to lose sight of them. Healthwatch will be more effective than the existing patient groups at monitoring local care, concerns and complaints. This patient voice alongside Health and Wellbeing Boards will improve local accountability and involvement with those commissioning healthcare. Whilst many PCT board meetings were open to the public, does anyone feel that the public had sufficient opportunity to influence decision making in their local NHS? These groups will be there to advise GP leaders what services they want to see commissioned and are a further protection against any inappropriate privatisation.

It is a shame that after decades of calling for clinical leadership and for politicians to stop interfering with the day-to-day running of the NHS, there are so many now calling for the reverse. Whilst the Bill establishes that responsibility for healthcare lies with the Secretary of State, he will be handing over the reins to the clinicians and an independent NHS Commissioning Board.

Whilst I still feel that this Bill could and should have been managed differently, it would be a shame to miss the opportunity for a clinically-led and locally-led NHS. The risks of going back now outweigh the risks of going forward and we should support the enthusiastic and committed teams taking it forward on behalf of their communities.