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At the heart of general practice since 1960

The BMA must hold its nerve

The backlash, when it came, was as fierce as it was predictable.

The backlash, when it came, was as fierce as it was predictable. The morning after the BMA announced the first industrial action by doctors since 1975, the national media let rip, and GPs in particular were the focus of their ire. ‘Doctor, doctor, why is my GP going on strike?' asked the front page of the Independent. ‘Because a £53,000-a-year pension deal isn't enough…'

The BMA has always been aware of the PR difficulties in taking a stand over pensions. But for rank-and-file GPs, the sheer vitriol of the criticism has come as a shock – particularly for those who have been directly challenged by patients.

Intellectually supporting doctors' right to defend their pensions from an unjustified hike in contributions is one thing. Explaining to an angry patient paid a quarter of what you are why he won't be able to make an appointment is quite another.

It's unsurprising, then, that many GPs are wavering. It remains to be seen how many surgeries do close their doors to routine appointments on 21 June, and some have yet to decide. But our snapshot poll this week suggests a fair proportion of the 79% of GPs who voted for action won't actually carry it out.

What can the BMA do to shore up support? For a start, it must lead from the front, and from the very top. That almost two weeks after BMA Council unanimously approved industrial action just one out of 10 GPs on BMA Council was able to confirm his practice would definitely be participating is surprising. And while the need to consult with partners is understandable, the refusal by some to even discuss their own practice's participation is less so. Grassroots GPs have legitimate concerns about patient safety, public perception and contractual repercussions, and certainly deserve to know whether their leaders who have drawn the battle lines will be leading them over the top.

Secondly, in order to achieve meaningful movement on pensions, the BMA will have to dig in for a sustained campaign – and show it is willing to do so. That means talking now about the possibility of further days of action. But it also means seriously considering action targeted less at patients and more at the bureaucracy of healthcare – including, perhaps, a boycott of commissioning.

Significantly, the LMC conference voted for just that last month, and the BMA's Annual Representative Meeting will consider a similar motion shortly. And even without official sanction there are signs that some GPs may quit commissioning groups of their own accord. The BMA so far has been determined to avoid conflating the NHS reforms with pensions. But targeting commissioning would give ministers pause for thought, and garner wider GP support.

Finally, media backlash notwithstanding, the BMA must hold its nerve. It is committed now, and must stay the course.

The protest on 21 June is more of a test for the BMA than the Government, to see if it has the grassroots muscle and political stomach for a fight. But if the day of action heralds a summer of doctors' discontent – and GPs' disengagement with commissioning leaves a vacuum just as PCTs start to wind down – it may yet be ministers who feel the heat.

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