A cultural revolution in the NHS to put wishes of patients before the convenience of professionals was promised by Tony Blair yesterday as the government launched a white paper offering choice from the cradle to the grave.

It said commuters in England will be given the chance to register with a GP near their place of work or get treatment at private healthcare clinics that will be invited to tender to provide free daytime services.

Patients will be able to get repeat prescriptions from a pharmacist of their choice without having to go back to their GP for up to a year. And, when new IT systems are installed before the end of 2007, they will be able to pick up repeat medicines at any pharmacy in England.

Expectant mothers will be able to bypass the GP and deal exclusively with a midwife, working out a birth plan after discussing choices of pain relief and place of delivery.

At the other end of life, more patients wanting to die at home will be given the chance to do so. Those with a progressive disease, such as Parkinson's, would be able to appoint a healthcare proxy with a legal right to be consulted about treatment when they can no longer express a choice.

The proposals came in the first big policy paper from John Reid since he became health secretary in June. It builds on his predecessor's plans to give patients waiting for an NHS operation the chance to get a quicker appointment at another hospital.

After collecting the opinions of more than 110,000 patients in a consultation exercise since August, Mr Reid has decided to extend choice to every aspect of primary care and chronic disease management.

Although he wants the private sector to play a larger role - including plans for chains of diagnostic centres where patients can get quick blood tests and X-rays without having to go to hospital - most of the reforms depend on changing NHS procedures and attitudes. No extra money was promised yesterday, but some may emerge in the next three-year public spending review. Mr Blair, launching the proposals at a breakfast seminar in Downing Street, said they marked the end of a "paternalistic" approach to healthcare in the NHS.

In future, patients would be expected to share responsibility with the professionals for deciding their treatment.

Harry Cayton, "patient tsar" at the Department of Health and the main architect of the white paper, said patient organisations should keep up the pressure. "I hope people will say: it is good, but not good enough, and we want more," he said.

The white paper was influenced by recent reform of social services in letting older people choose whether to get home support from the local authority or cash to pay toward help from friends. But Mr Reid has rejected cash payments to let NHS patients buy their own help.

The British Medical Association said the report contained "imaginative initiatives" to make more use of pharmacists and take strain off doctors.

Tim Yeo, the shadow public services secretary, said the NHS ranked between Slovenia and Poland in a recent survey of patient choice.

Prescription for change

· Patients to get choice of GP near work, plus out-of-hours service near home

· Private clinics to be available free as alternative to GPs in towns and cities; and nurse-led clinics in areas of high need

· Private fast-track diagnostic centres for blood tests and x-rays as alternative to hospitals

· Repeat prescriptions direct from pharmacist without needing a doctor's signature

· More medicines available over the counter without a prescription, but free to poorer patients

· New electronic NHS care records letting patients stipulate needs and wishes, including religion, diet and preferred form of address

· Hospitals to write direct to patients with copy to GP - not the other way round

· NHS Direct digital TV service to provide more information about health conditions and treatments

· Direct access to midwives and more control over birth plans

· Patients with chronic conditions to agree treatment plans

· Right for people with progressive diseases such as Alzheimer's to appoint healthcare proxies to be consulted about treatment when patients are incapable

· Right to die at home and better palliative care