By Liz Stephens and Alex Stevenson
General practice boundaries for patients are to be abolished, Andy Burnham announced this morning, allowing NHS patients to go to any doctor in the country they like.
Speaking at The King's Fund in central London, the health secretary said "service reform" would mean doctor choice would be led by patients' needs, "not by lines on a map".
The British Medical Association warned of "major logistical barriers" which will have to be overcome, however. Laurence Buckman, the chairman of its GPs committee, pointed out home visits would be difficult to fund and city centre practices could be inundated with appointment requests.
"These problems are not insurmountable but will need a lot of careful thinking if they are to be solved," he said.
Mr Burnham talked of "extending choice within primary care" and future plans for a "people-centred NHS".
He also refused to rule out cuts to the Department of Health, saying there may need to be fewer staff at the centre.
"We've got to look at everything - I'm not ruling anything out," he said.
"We may have to be tough on the backroom stuff."
His comments came just two days after the prime minister announced at the TUC conference that public spending cuts were inevitable. Gordon Brown ruled out cuts in "frontline" services, however.
Mr Burnham refused to talk of cuts, preferring to refer to "service reform" repeatedly.
He said that "quality cuts costs" - but not all were convinced.
John Appleby, chief economist of the King's Fund, said of his guidance: "What it doesn't tell you is how to do it - it just passes on the pressure."
Mr Burnham replied: "I think people will know how they can make savings at [the] local level."
The health secretary also announced his wish to de-authorise foundation trusts if they do not maintain improvements in quality.
He said he wanted to see payments linked to patient satisfaction and attacked the Tories plans for a "more variable and less accountable service" saying this would damage the NHS.
"Mr Cameron plans to turn it into the world's largest quango," he said.
However, Mr Burnham admitted that widespread reform would be necessary and efficiencies would have to be made in future.
"There needs to be a big culture change for the NHS," he said.