The British Medical Association has said significant changes to NHS reforms are still required to “mitigate the damage” they will cause, as peers prepared to debate afresh the government proposals.

Ministers are expected to meet one concern of critics by backing an amendment making explicit the responsibility of the health secretary to provide health services.

The BMA also welcomed a government move to table amendments itself “largely addressing” its concerns over education and training provision ahead of the detailed committee stage.

They still face a protracted struggle to secure approval of the controversial Health and Social Care Bill however, with the BMA setting out 10 further demands.

Among them are provisions to protect the principle of fair access against improving patient choice and to bear down on the potential for conflicts of interest in GP commissioning.

A BMA study found seven out of 10 GPs in England were concerned about conflicts of interest resulting from the reforms.

Dr Hamish Meldrum, the chairman of the BMA Council, said while it would prefer to see the bill withdrawn altogether there was “scope for further significant change”.

“We hope the Lords will agree with us and change the proposed legislation, limiting the damage this bill could do to the NHS.

“Because so much of the detail won’t appear on the face of the bill and will instead be left to secondary legislation and guidance, it is essential to have firm assurances now about the government’s implementation plans.

“For example, we continue to have serious concerns about the ethics of the current proposal to incentivise commissioners.

“Other areas where the BMA is seeking amendments relate to public health; the private patient income cap; the foundation trust failure regime; increasing bureaucracy and complexity, and information and confidentiality.”

Conservative peer Lord Mackay of Clashfern has tabled an amendment explicitly stating the health secretary’s responsibility for providing NHS services.

It is understood that the government will accept that change.

Earlier this month, peers rejected Labour attempts to kill off the bill and an attempt by former SDP leader Lord Owen to delay it by referring it to a special committee.

But during two days of passionate debate in the Lords, the reform plans came under sustained attack from many of the 100 peers who queued up to speak.

Prominent critics in the upper House include Liberal Democrat peer and former cabinet minister Baroness Shirley Williams.

Shadow health secretary Andy Burnham has pledged to continue fighting for “substantial and drastic” changes to the legislation if Mr Lansley is not willing to drop it.

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