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Meldrum rocked by ‘no confidence’ vote from BMA members over health bill opposition

By Andrew McNicoll | 19 Sep 2011

BMA chair Dr Hamish Meldrum is facing an unprecedented revolt from grassroots members, after a meeting of the BMA's largest regional branch passed an overwhelming ‘vote of no confidence' in his handling of opposition to the health bill.

 

A motion proposing ‘a vote of censure' in the BMA chair for his failure to promote members' views and campaign for the withdrawal of the bill was backed by 100 of the 110 doctors attending BMA London's AGM on Wednesday. GPs attending the meeting told Pulse that the move to formally censure Dr Meldrum represented ‘a vote of no confidence' in his leadership in opposing the reforms.

The motion also called for the BMA to launch a 'huge campaign' to get the bill withdrawn after doctors accused the BMA Council of failing to deliver on its mandate to mount a public campaign for the reforms to be scrapped. Doctors at the meeting claimed Dr Meldrum had ‘undermined' calls for the reforms to be scrapped by co-signing a letter to the Times which called for ‘further significant amendments' to the reforms rather than the bill's outright withdrawal.

The deep hostility from members in the capital puts Dr Meldrum under intense pressure as the association prepares to lobby peers to make further amendments to the bill. The revolt from BMA London marks the first time any BMA branch has issued a vote of no confidence in Dr Meldrum's leadership, and the first time BMA London has ever censured any BMA chair.

Dr Meldrum's predecessor as BMA chair, Dr James Johnson, was forced to resign in 2007 after members accused him of failing to represent their views over the MTAS scandal.

Dr Kevin O'Kane, chair of BMA London, told Pulse: ‘The motion of censure clearly shows London's doctors are not happy with the council for failing to fulfil its mandate and effectively campaign for the bill's withdrawal. There is anger that the message that this bill should be withdrawn is not being pushed hard enough by the BMA Council and its leaders.'

‘Council is undermining opposition to the bill by signing letters to the media about amendments rather than withdrawal. This bill is not fit for purpose, it is appalling, and no amount of tinkering will make it right. London's doctors are angry and they are not out on their own on this one. We are reflecting the message coming from doctors around the country.'

'At the SRM and the ARM doctors were asked not to pass motions to vote for total opposition to the bill because concessions would be won. The BMA claimed to have achieved concessions following the Future Forum but in my view there hasn't been a single concession. Neither does Andrew Lansley. He told his backbenchers that the bill was very much intact - and he's correct.'

Dr Meldrum was not available for comment. However a BMA spokesperson said:

‘The BMA has undertaken an extensive programme of public activity calling for the bill to be withdrawn. This has included high profile media coverage and an online day of action which saw the NHS trending in the UK's Top 15 issues on Twitter. Our position has been prominently communicated in the media, including a front page national newspaper story.'

‘We remain concerned that the legislation presents unacceptable risks to the NHS and will continue to call for its withdrawal. The BMA will continue to communicate its concerns to politicians, other organisations and the public until the bill is withdrawn or at the very least significantly amended, in line with the policies of the ARM and Council.

‘We continue to engage with all our members on this important issue, including seeking their views on the bill.'

In full: the BMA London motion

‘The BMA has been mandated by the SRM in March and the ARM in June to call for withdrawal of the Health and Social Care Bill. Council took this forward on the 20 July with a vote to start a public campaign for withdrawal of the bill. This meeting therefore:

1) Mandates the BMA leadership to mount a huge public campaign for withdrawal of the bill;

2) Proposes a vote of censure in the chairman of council for not promoting our views for withdrawal of the bill.'

READERS' COMMENTS

Ian Holliday, Other healthcare professional,
16 Sep 2011
Hmm, somewhat overdue but it may still give pause for thought in the Lords. Shame it is so late in the process..
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Robin Jackson, GP,
16 Sep 2011
Was this the BMA Conference or "Walking with Dinosaurs".The blinkered philistine views that you report are simply not representative of those of us who are now having real influence in our CCGs, backed by secret ballot mandate of our GP colleagues and working with an enthusiastic and dedicated group of former PCT staff.We may be lucky, but we have created our own luck by hard work, and we will be justifiably annoyed if a bunch of Luddites with a political axe to grind wreck these measure.Grow up!
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Vinci Ho, GP Partner,
16 Sep 2011
Political meaning of this revolt is more intense than the practical reality as the government is really not going to listen to BMA anyway with the back up from people like Master Yoda.
Problem is 'a vote of no confidence ' should be against Cameron and Lansley . A civil war inside BMA right now will make the situation even more unpredictable . I suppose there is an outcry for Meldrum to step down . The issue of pension crisis also renders him as a 'soft' leader .
This is critical time in history of general practice .............
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Simon Ruffle, GP Partner,
17 Sep 2011
Ask a room of ten doctors and you'll get 11 opinions.
GPs are a varied group of people with strong views. Some may think they will best serve patients by being active in CCGs others feel they are best placed in the consulting rooms and others by being union leaders.
As a GP all of them will be quite good a weighing arguments, facts and fables and coming up with a decision or opinion-it's what we do; as long as the patient and the community we serve is at the heart of the decision then it's probably right. AND that includes looking after each other and working together.
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David Brownridge, Sessional/Locum GP,
17 Sep 2011
Have the lessons of the GP Fundholding fiasco not been learned? The BMA never prospered from its opposition to it as,just as now, there is a minority of the Profession who are determined to follow the political dogma despite the mood of the health-caring professions and the sway of opinion in the country. Remember the Bill was not in the Election manifestos. Talk about the tail wagging thedog-we have been here before-politicians love to divide and rule.
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Clare Gerada, GP Partner,
17 Sep 2011
Can we remember what the problem is - the problem is NOT with GPs being involved in planning services for their patients - the problem is the system under pinning our NHS such that it is being dismantled and opened up to the corporate, for profit, largely US heath companies. At the same time that the provider side is being opened up - so to is the commissioning side, with CGCs inevitably being enticed to hand over large amount of their functions and money to large consultancies.

This will happen because of the perverse incentives of the market - such that hospital providers and AQPs will increase costs to meet their costs (and game, upcode, do unnecessary procedures etc). This will mean that CGCs will have to deny care to stop their patients using expensive resources.

The whole system will mean - worse care for patients, less choice, increasing waiting lists, direct advertising, decreasing services provided free by NHS - and the patient will be seen as a commodity - to gain money from. GPs life will be spent denying care, "rationing", implementing delaying tactics (such as referral management systems) and GPs will be de-professionalised by endless monitoring and auditing against financial performance targets.

Clinical meetings will be dominated by the language of the market - so case management, care pathways, referral management, frequent flyers, demand management to name but a few words that have crept in over the last few years.

We must not have a split between GPs and consultants, BMA and other colleges and between pathfinders and other GPs

This is the time to come together for our patients and to make sure what ever happens does not create increase inequalities and reduced care or quality

Clare
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Vinci Ho, GP Partner,
17 Sep 2011
For those of you who are still Lib Dem supporters(!) , this is the last chance to bombard and 'bully' Nick Clegg and more importantly those LD MPs who are against the current version of the Health Bill and will speak out in this Lib Dem conference (If you think they still want your votes in the next election of any sort)
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Anonymous, Other healthcare professional,
18 Sep 2011
Hearing that one PCT was considering whether or not to even put the NHS branding on their CCG web sites; alongside a statement made by a director in our Local Authority that Landsely is just waiting for his reforms to fail so that he can "privatise" the NHS ...... watching Dr S Field claim that GPs should be commissioning GP services with all that conflict of interest ...... watching some brilliant GP commissioners commission and there again some GP engage in commissioning who I really wouldn't want to go to for GMS never mind Commissioning decisions. Where are we going with all this? Makes me wonder whether we will ever pass an NHS on to the next generation .......... or is this actually what the Tories want? For goodenss sake GPs you are the only professionals that can ensure the safety of our NHS for future generations. Where has your passion and drive gone?
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Marie-Louise Irvine, GP Partner,
18 Sep 2011
The point is that the BMA promised a "public campaign" and did not deliver. The Twitter thing was only one day and was aimed at the medical profession, not the public. The stuff on the website about writing to your MP was also aimed at medics. The information on the BMA website for the public is very sparse. The Look after our NHS section is hopelessly out of date. It still contains the same leaflets and posters that were created two years ago for the campaign against Labour's private tendering of practices and Darzi polyclinics. There is no new literature for patients about the health bill. Call that a public campaign? A public campaign should have produced leaflets and posters for our patients informing them about the bill and printed post cards for our patients to send to MPs and Lords. The BMA should have organised public meetings and events, a big media campaign including more imaginative use of electronic media, petitions, full page ads in daily papers, billboard ads, combining efforts with other health unions to share costs and maximise impact. The public are still largely unaware of the meaning and impact of the bill. They keep being told lies "no top down reorganisation" , "we will never privatise the NHS", "significant amendments were made following the pause" and so on. Why? Because the coalition government knows that if the public knew the truth about this bill it would not last a day. The government wants to keep the public ignorant - its the BMA's duty to tell the truth about what is at stake through a public campaign. This is BMA policy and we want the BMA leadership to carry out BMA policy. Is that too much to ask?
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Anonymous, Practice Manager,
19 Sep 2011
Long overdue and not just in relation to this latest fiasco.
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Anonymous, PCT,
19 Sep 2011
What a good debate above - the best one for some time. Its a shame that the one person standing up for the new system is the only one who thinks slagging off his colleagues as luddites, dinosaurs etc is ok.

There are lots of GPs involved in CCGs - lets get that straight. What they fail to understand properly (and I'm not sure what blinds them) is that the system stops commissioners from succeeding. Dr Gerada points this out above and also highlights how the White Paper will make things worse.

PCT Finance Manager
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Paul Conroy, Practice Manager,
19 Sep 2011
The fundamental issue is transparency. 'No decision about you without you' should be true of us, as well as our patients. Yes, empower clinicians to direct care, but be honest about what you're giving them, and don't try to pull the wool over the eyes of the proffession or the public. Whatismore, keep the NHS we are all so proud of safe...whether from McKinsey et al, the CQC or the bean counters.
This vote in London will be valuable if it causes the BMA to grow a pair and tackle the government head on about its honesty with the electorate and the NHS. If it divides us, we have no hope of causing lasting and positive change to policy or organisations. The key themes of the passionate debate around this issue need to be drawn by the BMA into a symphony of concern for an issue at the heat of Brittish society, not divided into their component parts and displayed as dischord. We don't fundamentally disagree about many key issues - we just need to admit that we don't have all the answers and agree what the questions are.
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Peter English, Sessional/Locum GP,
19 Sep 2011
My grouse is the lack of clarity from the BMA and Royal Colleges (though the BMA has improved recently).

Instead of saying:

"This bill is not fit for purpose, and we cannot support it. There may be a few things in it that we would welcome; but the damage this bill will do if passed greatly outweigh these benefits."

they said (paraphrased of course):

"We welcome [this that and the other]. But the bill will need a lot of amendments if it is not to do more harm than good".

This approach means that if you only read the first bit, you get the impression that the body endorses the bill; and the second bit suggests that the bill can be improved to a point where it is acceptable.
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Anonymous, PCT,
19 Sep 2011
Clare

Why are you so opposed to "the problem is the system under pinning our NHS such that it is being dismantled and opened up to the corporate, for profit, "

This is the system that general practice has used since the inception of the NHS. I think that it is a bit much for GP's who are happy making profits from the NHS complaining that someone else cant make a profit. I think that both primary and secondary care should be either opened upto competition properly or both parts should be a national service and not contain profit based companies.
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Anonymous, PCT,
19 Sep 2011
anon PCT - GP practices making 'profits' is just a mechnism to provide GP partners with an income. To say this is wrong is like saying that you shouldn't be paid a salary. OK - they are private organisations but their aim is to provide a service to the public rather than to provide whatever bits of a service they see as profitable.

Contrast this with those private healthcare companies whose aim is to maximise profits for their shareholders. What do they really care for universal provision of free healthcare? Look how privatisation of railways has caused such a mess - old rolling stock, providers exiting from unprofitable contracts, public subsidies galore. You'll get more of the same.

PCT Finance Manager
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Anonymous, Practice Manager,
19 Sep 2011
All too late in the day I fear
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Anonymous, PCT,
19 Sep 2011
Its a vote of no confidence in Lansley thats needed - unless he goes any amount of challneging will be pointless and have no effect.
6 years of brewing has allowed him to boil up a poisonous mix for our NHS- Once its gone its gone.
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Robin Jackson, GP,
19 Sep 2011
I stand by my comment about Luddites.In my CCG, we are making significant changes to clinical care for the first time since Fundholding was abolished.Who benefits? Not Andrew Lansley, but OUR patients.
My main provider Trust is graded Red by Monitor and is the subject of a CQC and police investigation. I personally had experience of another NHS Trust where I had to wait 12 weeks for the treatment of a condition that would have been seen in days in the US or Europe.The "outpatients" was a dingy side corridor, with no reception until a nurse came by 30 minutes later.I was eventually seen two hours after my appointment time.As a GP of 30 years standing, I am strongly committed to a health service funded centrally, but those whose dogma ties them to THE NHS rather than an nhs, risk doing our patients a disservice.
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Anonymous, PCT,
19 Sep 2011
Anonymous, PCT, 19 Sep 2011

I disagree. Practices in my patch do focus on the more profitable bits and comply with the rest of the contract. A number of partners have told me that they calculate how profitable different QOF points are and enhanced services based on what needs to be done before deciding whether they choose to do it / offer the service.

Im not suggesting that GP's should not get paid, far from it. And I think that a good salary around the £100k mark is not an unreasonable figure given the training and responsibility involved. However this is way lower than many practice partners are earning.

Perhaps Pulse would like to do a survey and findout what sessional /hourly rates CCG's are paying for GP time. That would be interesting to see and give a good indicator of true GP income.
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Anonymous, PCT,
20 Sep 2011
Robin Jackson

You are effectively calling for an insurance based system as per the USA. No public funded free to all service can possibly provide treatment 'within days'.

If you care to study such systems you will find that premiums rise as people get older and god help you if you make a claim. That is why there are loads of people in the States without any cover - its unaffordable.

Private providers within the NHS will simply do what they want to satisfy the needs of their shareholders. If you really want decent wards and appointments to time you need to campaign for better investment in NHS Trusts. They can't invest as they are too busy fighting for income all the time.

I wish your CCG good luck. I think that you'll find your gains short lived as the system takes over.

PCT Finance Manager
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