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Reward for Meldrum's realism, relief for Lansley - but the BMA's vote will cast a long shadow

Pragmatism carried the day at the BMA's Special Representative Meeting, writes Pulse deputy editor Steve Nowottny. Has GP opposition to the NHS reforms just bottomed out?

Pragmatism carried the day at the BMA's Special Representative Meeting, writes Pulse deputy editor Steve Nowottny. Has GP opposition to the NHS reforms just bottomed out?

In the end, the BMA's first Special Representative Meeting for 19 years, which saw hundreds of GPs and doctors from across the country convene in central London to spend hours debating a 48-page agenda filled with more than 200 motions, really came down to just two votes.

Just after 5pm yesterday, after mounting anticipation throughout the day, delegates narrowly rejected a motion claiming that, as far as the Health and Social Care Bill was concerned, ‘the BMA stance of "critical engagement" with the Government failed'.

Seconds later, they rejected a second motion (or technically, a second part of the same motion) calling on the BMA ‘to oppose the bill in its entirety'.

There were many other significant votes, of course, and this morning's headlines will not make easy reading for health secretary Andrew Lansley, after delegates queued up throughout the day to denounce his NHS reforms. A strongly-worded motion calling for the health bill to be withdrawn and for a ‘halt to the proposed top down reorganisation of the NHS' – while slightly hard to reconcile with the BMA's decision not to vote for outright opposition – speaks volumes about GPs' unease with ministers' direction of travel.

When the dust settles though, Mr Lansley will not be displeased with the outcome of the meeting.

GP support for his commissioning plans has been falling steadily since he first published his white paper last summer, with the extent of the profession's opposition made clear in recent polls of both the RCGP and also the BMA itself. Criticism of almost every aspect of the reforms has reached a shrill crescendo in recent weeks – now, at last, there's a suggestion that GP opposition to the plans could have bottomed out.

In fact, judging by some of the rhetoric which has been bandied around recently, it seems almost impossible that Mr Lansley could survive a vote of no confidence from a room-full of fired-up doctors' representatives – but survive he did.

In any event, for all the rhetoric, yesterday's meeting was ultimately less about what GPs think of the Government, and more about what they think of the BMA – and the man who had most to lose was not Mr Lansley, but BMA chair Dr Hamish Meldrum.

For all Dr Meldrum's blithe insistence that the Special Representative Meeting was held ‘because we thought the time is right', it was a meeting the BMA leadership never wanted to hold.

The BMA Council only voted reluctantly in January to hold the meeting, at the third time of asking, and after heated debate. (I'm told Pulse's survey showing that an overwhelming majority of GPs both for and against the reforms wanted the meeting to be held had some influence, although Dr Meldrum was heard to remark sharply that Pulse do not set BMA policy).

Once the clamour for the meeting became impossible to ignore, the BMA leadership switched to damage limitation mode.

A number of motions demanding outright ‘industrial action' were carefully grouped with vaguer 'Agenda Committee' motions calling for ‘forms of action' to be considered, while other motions were carefully scheduled permitting members to vent their anger in less politically incendiary ways.

Dr Meldrum, meanwhile, gave one of the speeches of his life, a carefully crafted address striking exactly the right balance between anger (‘I do not support this bill. The BMA does not support this bill. The profession does not support this bill') and pragmatism (‘We need to be realistic about where we are now and what we wish for').

Ultimately, for all the harsh words, it was pragmatism which carried the day. Yesterday represented a resounding victory for Dr Meldrum, and while hardliners will continue to campaign actively for stronger opposition to the bill – starting at the BMA Council meeting today – the wind has been very publicly taken out of their sails.

Where the profession now goes as it struggles to come to terms with the NHS reforms is less clear though.

BMA members have set out the limits of their opposition to the Government's plans, and no matter how strongly Dr Meldrum and GPC negotiators make their case in future, ministers will be mindful that they have no democratic mandate for outright opposition or industrial action. The Special Representative Meeting will cast a long shadow over the coming weeks and months of ‘critical engagement'.

In his keynote speech opening the meeting yesterday morning, Dr Meldrum implored representatives not to ‘tie the hands of those who work and negotiate on your behalf'.

They listened, and voted the way he'd asked them to. But he may find his hands have been tied all the same.

Steve Nowottny is deputy editor of Pulse

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