Exclusive The BMA has begun drawing up a detailed list of options for how GPs and other doctors could take industrial action over pensions, including working to rule and non-cooperation with NHS bureaucracy, in the expectation that last-ditch talks with ministers will fail to yield concessions.
Doctors' leaders are understood to also be considering ‘working without enthusiasm' and more radical options such as offering an emergency-only service, while one BMA Council member is proposing GPs could protest by becoming ‘very cautious' and overwhelming hospitals with referrals.
The BMA's list, which will outline the pros, cons and legal implications of each option, will be presented to BMA Council at an emergency meeting on 25 February, where BMA leaders will decide whether to ballot members on the first industrial action by doctors since the 1970s.
A ballot on some form of industrial action now appears increasingly likely after health secretary Andrew Lansley refused to re-open key elements of the Government's final pensions offer and warned the threat of action would win ‘no concessions'.
His comments came in a defiant response to the release of the results of the BMA's survey of 46,000 members, which found 84% opposed the offer and two-thirds backed some form of industrial action.
Pulse understands the BMA has ruled out all-out strike action, but working to rule and a number of variants are under discussion, including boycotting form filling.
GPs who have been involved with commissioning said they were preparing to quit in protest at the pension squeeze.
Given the complications of the different contracts in different branches of medicine – for example, GP partnership law – the BMA is taking external legal advice, as well as consulting its own lawyers, to ensure any ballot on industrial action is robust and could not be derailed by a legal challenge.
A BMA source said different action by different branches of its membership remained a possibility. Any major Government concession would be likely to be put to a further vote of members, the source said.
A senior GP on BMA Council suggested doctors could refuse to ration NHS resources: ‘If someone comes in with knee pain, we don't give it time – we refer them. I wouldn't do anything that is wrong, but I could practise in a very different way to currently.'
Dr David Bailey, vice chair of the BMA's pensions committee and a GP in Cardiff, refused to speculate on the types of industrial action under discussion, but confirmed a list of options was being drawn up.
‘Those options will be placed in front of the special meeting of BMA council on 25 February,' he said. ‘At that stage – assuming the Government, which seems highly likely, refuses to re-open negotiations – we will have to take a decision on whether or not we ballot.'
BMA chair Dr Hamish Meldrum – who will shortly meet Mr Lansley for crunch talks – said ‘the strength and scale of feeling among doctors is abundantly clear', but insisted industrial action remained a ‘last resort'.
But BMA sources were downbeat on the prospect of ministers changing their stance, after health secretary Andrew Lansley said the ‘heads of agreement' document that sets out the Government's ‘final position' on pensions would not be subject to further negotiation.
‘What Mr Lansley's basically saying is: "This is what we're offering and it isn't going to get any better",' the source told Pulse.
Dr Sunil Sapre, a GP in Liverpool, said the BMA's decision to draw up plans for industrial action was the ‘right decision in the interests of the profession'.
He added: ‘Now make sure the action hurts the Government but not patients.'
The road to a BMA ballot
19 Dec 2011: Ministers table final pensions offer
5 Jan 2012: BMA polls 130,000 members on final offer
18 Jan 2012: BMA rejects pensions offer after poll finds 84% opposed to deal
Next few days: BMA chair to meet Andrew Lansley for talks
Next few weeks: BMA draws up options for industrial action
25 Feb 2012: BMA Council due to hold emergency meeting to discuss ballot
