A warning by the head of the NHS that the Government's controversial health reforms could end in "misery and failure" has sparked fresh Labour calls for parts of the shake-up to be halted.
Chief executive David Nicholson, the Observer reported, told a recent conference of GPs that he also had concerns about "carpet bombing" privatisation of services.
It said that while he expressed hope that the changes would improve some failing services, he raised concerns of a "massive problem" if doctors took on too many bureaucratic responsibilities.
"Big, high-profile, politically driven objectives and changes like this almost always end in misery and failure," he is reported to have told the conference - based on his experience of the national IT system fiasco.
And echoing comments by the chair of an influential House of Commons committee he said increased competition "is very effective when it is used as a rifle shot to deal with specific issues rather than a carpet bombing".
The comments were part of a speech, a source close to Mr Nicholson told the newspaper, aimed at rallying GPs to work with the changes.
But shadow health secretary Andy Burnham said it showed a crisis in confidence getting "deeper by the day" - and called for a suspension of the latest wave of contracts being put out to tender.
He said: "We knew there were widespread professional concerns about Government plans to turn the NHS into a free market but it is now clear they go to the very top. Jeremy Hunt should take a One Nation approach and listen to a man of David Nicholson's experience in the NHS. He should call a halt to the expansion of the Any Qualified Provider process and the top-down privatisation of NHS services."
A Department of Health spokesman said: "David Nicholson was speaking in favour of increased autonomy of our NHS, and about strong local leadership of health care, which is something the Government greatly supports.
"We are modernising our NHS so it can continue to improve patient care, and so that we can deliver more support and care in the community for people with long term conditions like dementia, heart disease and diabetes. Doctors, nurses and healthcare professionals - the people who best understand the needs of patients, will be put in charge of running our NHS."