Sir Keir Starmer has promised to overhaul GP services if he gets into power, saying the NHS will “die” without drastic change.

The Labour leader revealed his plans in the Sunday Telegraph, including making family doctors direct employees of the NHS and allowing patients to self refer to specialists.

Speaking to broadcasters later, he issued a stark warning about the service, saying: “Frankly, if you don’t reform the NHS then I fear it will die.”

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Dr Philip Banfield, chair of the British Medical Association, criticised the plans, saying GPs were “one of the most efficient and effective parts of the health service”.

Labour has already unveiled some of its proposals for the NHS if it took power at the next election, including funding more medical school places by scrapping the non-dom tax status and introducing a 10-year plan for reform.

Sir Keir gave more detail today, with a focus on primary care, saying: “When people can’t walk through that front door they inevitably end up going through another, more expensive one – the hospital.

“Quality care in the community provided by GPs is the difference between a diabetes patient living a happy, fulfilled life versus needing an emergency amputation. It is that stark.”

Writing in the newspaper, he said he would phase in a new system as existing GPs retire, replacing their contracts with direct NHS employment for new practitioners, allowing them to “focus on caring for patients rather than the admin that comes with effectively running a small business”.

He also said he would “be ruthless with the bureaucratic nonsense”, so, for example, people with back pain could refer themselves to a physio, or people needing tests could do them at home, rather than going through a GP.

Speaking later from central London, the party leader said: “I am a passionate defender of the NHS but in order to preserve the NHS going forward it has to change.

“And what we have seen is the worst NHS crisis under this government and every year it just gets worse. I think if we reform the NHS we can… make it fit for the 21st century and have it absolutely focused on patients.”

‘Managed decline’ under Tories

Sir Keir attacked the government’s handling of the service, accusing them of “just presiding over the managed decline – and that I will not accept for a Labour government”.

He also headed off his critics, pointing to his previous work running a public body.

“I have long believed in reform of public services,” he added. “When I ran the Crown Prosecution Service I could see the reform we needed.

“We will always have, whether it be the NHS or any other public service, people who say, ‘well don’t do it, it has always been done this way’. They are nearly always wrong.

“Of course there will be challenges whenever you reform something but frankly, if you don’t reform the NHS then I fear it will die.”

Dr Banfield is one of those against the changes, specifically the plan for self-referral.

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He also told Sky News about his wife’s experience spending 12 hours on an A&E trolley.

He told Sky News’ Sophy Ridge that he had met with Labour’s shadow health secretary Wes Streeting this week to discuss the proposals and “we had to agree to disagree”, with the chair claiming the MP “doesn’t understand general practice”.

“GPs are one of the most efficient and effective parts of the health service in the way that they manage risk, they are superb at it,” Dr Banfield added.

He also said Labour “have a lot of work to do between now and an election” to get his organisation onside.

“We have offered to help them with that and we’ll do business with anyone who has the right policies,” he said.