Everything seems set up for one almighty collision. At one end, the BMA is now armed with the backing of two-thirds of its members as it threatens industrial action over pension reform. At the other, health secretary Andrew Lansley is insisting there will be ‘no concessions', and has given clear licence to his dogs of war at the Daily Mail to go for GPs' throats, with his declaration that the public would ‘not accept, nor understand' the BMA's position. A series of national newspapers have already run bitingly negative stories focusing, among other central issues, on the size of BMA chair Dr Hamish Meldrum's pension pot. It's hard to foresee a happy ending to this one.
So what exactly are GPs' options? Every leading voice in the profession, including GPC chair Dr Laurence Buckman in this issue of Pulse, has ruled out any kind of full-on strike that could put patient care at risk. But the most popular option in the BMA's survey was the one offering ‘other industrial action/emergency cover', and as such there is still plenty of scope for GPs to cause a bit of a stir. It's unlikely GPs will take any action that closes practices and puts primary care on an on-call-only footing, but other more symbolic protests are being considered. GPs could boycott paperwork, work to rule or, slightly oddly, work ‘without enthusiasm'. Some leading GPs have even suggested working with too much enthusiasm, by sending every vaguely suspect patient to hospital, merrily ordering batteries of lab tests and prescribing only the finest branded drugs.
The obvious target for GPs' ire would of course be the Government's NHS reforms – but here the BMA is reluctant to take action, warning it would conflate two different policy issues. As yet there has been no call from doctors' leaders for those spearheading clinical commissioning groups to down tools, or conversely begin furiously spending the NHS budget on homeopathy or acupuncture.
But if health secretary Andrew Lansley believes his reforms will escape the brunt of GPs' fury over pensions, he could be in for a shock. His response to the pension vote was startlingly unconstructive. It was one thing to reject the BMA's position, but quite another to deride the turn-out, send his media heavies into action and disingenuously claim doctors' leaders were going back on an agreement to accept the Government's offer. This is a man in no hurry to make friends.
And there are signs Mr Lansley's attitude could be losing him some of the few friends he had among GPs. One GP working on a CCG commented on Pulse's website: ‘Fine Andrew. Let's see how well you get on with your NHS plans when we all resign from commissioning groups.' Another said: ‘Lansley has blown it with me. I had a serious interest in commissioning work – I simply don't want to know now.' The BMA may be reluctant to derail the NHS reforms in protest at the pensions squeeze – but there are signs that GPs on the ground may be far less squeamish.
