The public white paper lacks clarity on several crucial issues, both the NHS Confederation and the BMA have said.

NHS Confederation deputy policy director Jo Webber has warned that the paper is not clear on how GPs and local authorities will work together in their new capacities as commissioners and directors of public health respectively.

And BMA GP committee chair Laurence Buckman told HSJ: “There are odd things in it [the white paper] that I don’t understand – which is true of most of what the government says on health.”

Ms Webber said: “The white paper needs to be the start of a process of bringing together all the services and initiatives which help to support a healthier population. This kind of overarching approach is particularly important in improving mental health and wellbeing where community-based services are vital.

“The big risk is that there is a lack of detail about what incentives there will be to encourage each part of the system to work together and also how to ensure clear accountability.

“For example, it is vital there are strong links between GPs and councils so they work together to improve public health. Without greater clarity on these issues the risk is that the reforms will flounder in confusion and a lack of coordination.

Dr Buckman said major questions remained to be answered and that currently there was a big shortage of public health physicians who would be vital to making the plans work.

“There is concern about how public health will fit into local authority agendas. Certainly there are doctors who think that is a good thing but can’t see how they fit into it, it rather depends how the public health service is going to be organised,” he said.

“We certainly don’t have enough public health physicians and we need a whole series of initiatives to get public health where it used to be.”