The NHS should be run outside politics by a board appointed by Parliament, the British Medical Association says.

The NHS should have its own constitution and make clear that it cannot provide everything possible, focusing instead on core services that meet the needs of the great majority of patients most of the time, it says. These changes would prevent day-to-day political meddling and let patients know what they could expect, the BMA says in a discussion paper.

The plans arise from dissatisfaction among the medical community about the Government’s reforms, James Johnson, chairman of the BMA Council said. There was “intense unhappiness” in the entire workforce, with reforms that lacked logic or coherence. Professionals had been marginalised by changes over 15-20 years, and the “constant dabbling” by politicians was dividing managers from clinicians, he said.

The recommendations envisage the NHS as an organisation that is a cross between the BBC and an old-style nationalised industry: run by a board, reporting to Parliament, and governed by a constitution that would set out principles, rights, and responsibilities. Patient input would be strengthened by greater local involvement, the division between purchasers and providers eroded if not abolished, and clinical leadership given greater priority.

Mr Johnson, a surgeon, said that the current reforms were “probably just about as unpopular as you can get. They lack cohesion; they are contradictory.

“It is absolutely right the politicians set the guidelines, but day-to-day dabbling when a particular topic becomes headlines is not good for the service,” he said. For the Secretary of State to have to react to every local eventuality “can’t be the best use of Cabinet ministers’ time. We think the way forward is for the service to be vested in a board of governors. The Government would set the amount of money and the general direction of travel for the NHS without any further interference.”

The board of governors would ensure compliance with the NHS constitution. It would appoint an executive management board, to include the NHS Chief Executive and Chief Medical Officer.

Some rationing of services appeared inescapable, Mr Johnson said, as treatments became more costly and the population aged. The list of services provided should be decided through debate between politicians, professionals and the public.

Hamish Meldrum, chairman of the BMA’s GPs committee, said that this did not mean the association favoured rationing. “We will continue to press for all necessary resources, but we do believe rationing may be inevitable. What we are recommending, if rationing is to take place, is that it’s done in an open manner.”

Andy Burnham, the Health Minister, said: “We resist any call to make the NHS a slimmed-down, emergency service, because that’s what it would become if we started rationing care. The NHS should continue to be comprehensive and universal. Further independence within the NHS should be considered only if it improves services. We are already devolving decision-making. ”

Andrew Lansley, the Shadow Health Secretary, thought the BMA was too pessimistic, and that bureaucratisation and demoralisation could be reversed. “I endorse some of the principles – taking politicians out of the day-to-day running of the NHS; reengaging professionals and focusing the Secretary of State and department on public health challenges,” he said.

Nigel Edwards, of the NHS Confederation, which represents most NHS organisations, said that producing a written constitution would be extremely difficult. “The NHS exists in a cash-limited system and has a multitude of competing priorities,” he said. “It is extremely difficult to reach a consensus on expensive drugs and treatments that pleases everyone.

“We need to confront the reality that if the public do not want cost to be a factor in NHS decisions, they may have to prepared to pay more.

“The confederation agrees that the NHS should be more independent of central government control. However, the structure of this is less important than ensuring devolution of power to local trust level.”

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