DAVID CAMERON refused yesterday to rule out a return to lengthy hospital waiting times, as it was revealed that his controversial NHS revolution would cost £1bn in redundancies alone.

The Prime Minister twice ducked a Labour challenge to guarantee that the shake-up – to introduce a system in which private companies compete to run services – will not lead to patients waiting longer for treatment.

Instead, Mr Cameron accused Labour leader Ed Miliband of wanting to “keep the bureaucracy” in primary care trusts (PCTs), which will disappear when GPs assume responsibility for commissioning care.

He told MPs: “We will not be able to get waiting times down and improve our public health in this country unless we cut bureaucracy in the NHS. That is what this is about.”

In fierce exchanges, Easington MP Grahame Morris said private health care companies had donated £750,000 to the Tory party, asking: “Does the Prime Minister see the conflict of interest?”

Bishop Auckland MP Helen Goodman said NHS cuts were already beginning. She said: “The County Durham and Darlington trust has been told that it must make cuts of 16 per cent over the next four years.”

The clashes came as the bumper health and social care bill was published, amid growing Conservative nervousness that the overhaul carries risks that could make or break the Government.

The dramatic shift will cull more than 24,000 management staff, including several thousand in PCTs in the North-East and North Yorkshire.

Consortia of GPs will control 80 per cent of the NHS budget, buying services from providers in the public, private and charity sectors, who will compete on price.

Already, trial schemes have been announced that will cover 1.7 million people in the region, attending 241 GP surgeries – including all 90 practices in County Durham and Darlington.

But there are fears that NHS hospitals will go bust if private firms grab large chunks of their revenue, perhaps by cherry-picking the easiest treatments and by offering so-called loss leaders.

Critics have also questioned whether GPs have the skills to handle such huge budgets – amid evidence that some are already turning to health companies to do their commissioning work.

Yesterday, the Royal College of General Practitioners became the latest body to voice concerns, suggesting the shake-up could lead to “fragmentation and unnecessary duplication” and sever links between primary and secondary care.

But Health Secretary Andrew Lansley said a national independent board would support GP consortia. Regulators would step in to ensure essential services continued if trusts went to the wall, he said.

While the overhaul would cost £1.4bn, including £1bn in redundancy costs, it would be paid for through savings within two years – saving £5bn by 2015.

But Mr Lansley declined to cap the earnings of GPs in leading consortiums. One in eight family doctors already earns more than £250,000 a year.