Ministers must do more to show how reforms to the NHS will be pushed through without hitting patient care in what may be "the toughest year" in its 62-year history, a leading body has warned.
Nigel Edwards, acting chief executive of the NHS Confederation, said the Government had so far failed properly to explain how it would manage the move to a radically different set-up or protect accountability.
The head of the independent membership organisation, whose call is published days after expert warnings that waiting lists could rise without extra Government investment in the health service, indicated that he backed the principle of the radical shake-up.
GPs will take control of most of the multibillion-pound NHS budget by 2013, planning hospital care and services for patients in a sweeping reform that will see primary care trusts and strategic health authorities abolished.
The Confederation supported the objectives and also recognised the need for the NHS to cut costs in line with the squeeze on public spending - from which it has been directly spared - but retained serious concerns, he said.
"2011 will be really tough for the NHS, possibly the toughest year it has faced. If the issues are not fully recognised, they will be dealt with poorly and patients will be the losers," he told members.
"The NHS is going to have to get all hands to the pumps and it will need all the help it can get. We need policy-makers to fully understand the pressures, to act to mitigate the risks and to persuade those involved that we are on the right course.
"The mechanics of who does what to whom and who oversees it is done correctly will be central to making the new system work. It needs to be crystal clear but it remains a grey area and is therefore one of the biggest risks to the reforms working.
"Parliament will also have to grapple with the issue of whether the reforms are powerful enough to achieve their goals.
"However, it is the transition that is causing greatest anxiety to the NHS and we have to get there first. That will mean avoiding hazards such as financial problems and failings in patient care."