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Rift in the BMA over reforms stance

Doctors upset with the British Medical Association stance of ‘critical engagement’ with the Government over NHS reforms could topple chairman Dr Hamish Meldrum and take the organisation in a more radical direction.

Reports suggest that doctors are proposing motions attacking the BMA leadership at its special representative meeting on March 15 – its first for nearly two decades.

A source told the Guardian newspaper: “If the BMA commits itself to total opposition, Hamish can't stay.”

Many doctors among the 140,000 membership want the BMA to take a harder stance against the reforms and surveys have shown many are deeply opposed, especially to the principle of introducing more competition into the NHS. Meldrum has also said the Government has not changed course based on the detailed concerns and recommendations of the BMA, leading some to question the benefits of the ‘critical engagement’ policy he has been heading.

But the general principle of GP-led commissioning has broad support in the BMA.

Dr Nigel Watson, chairman of the commissioning and service development subcommittee of the BMA general practitioners committee, told National Health Executive: “I don’t think that anybody would argue with the principles of GP-led commissioning, working more closely with secondary care and better integration with social care.

“Practice-based commissioning was strangled because of PCTs’ unwillingness to allow it to have any real impact or influence – and also because everybody spent their time waiting for the next bit of guidance to come out of the Department of Health. So if this is going to work it has to be non-bureaucratic with a light touch and adequately resourced.”

He said there “wasn’t a risk” of profits coming before patient care if the NHS is opened up to more private providers, saying: “I don’t think the consortia will be able to push money into general practice in a way that makes profits for practices. I think that as the consortia will be GP-led, they will be much more effective at developing care pathways and implementing them without the bureaucracy which happens at the moment.

“There is a huge amount of frustration felt when clinicians try to develop services and find they are either blocked or simply not implemented. So I think if clinicians work together we can develop services which are better for patients and better for the taxpayer.

“We all realise there is only a limited sum of money available and that we have got to make the maximum amount of use of that money. I think that if GP-led commissioning is supported in the right way, we can make much better use of the limited resources we have got.

“I don’t actually agree with the idea that GPs will become rich from the new system because they won’t be paying themselves to do things.”

Watson told NHE that his and many doctors’ chief concerns were not with competition in the health service, but rather with the practicalities of things like performance lists, premises funding and IT infrastructure, as well as developing primary care if the contract is at commissioning-board rather than PCT level.

But he added: “This means that there are whole swathes of risk which people just do not know enough about to really be either positive or negative about yet.”

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