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Leaked emails reveal pressure within BMA for GP commissioning boycott

Exclusive: GP leaders are facing mounting pressure to take a much tougher line on the NHS reforms and consider a profession-wide boycott of commissioning, after intense behind-the-scenes lobbying from some of the BMA’s most senior figures.

A series of emails circulated on the BMA Council’s internal email list, anonymously leaked to Pulse, lift the lid on the fierce ongoing debate among council members, with some calling for a mass withdrawal from commissioning or legal advice on possible industrial action.

Pulse understands that many of the concerns raised, under the subject line ‘It’s all going horribly wrong’, will be debated at the next BMA Council meeting on 27 September.

Dr Jacky Davis, a BMA Council member and consultant in north London who has long opposed the NHS reforms, apparently began the thread, asking: ‘Dear Laurence and other GPs – time to discuss withdrawal from commissioning? It’s still not too late but suspect it will be soon. Many feel BMA/GPC leadership urgently required.’

Dr Bob Morley, Birmingham LMC secretary and another BMA Council member, wrote: ‘The so-called clinical commissioning agenda and contractual obligation of practices to be the constituent members of the statutory rationing bodies puts tens of thousands of BMA members in a position of impossible conflict with their professional responsibilities to patients.

‘We need to take an unequivocal position, both to the public and the profession, against the CCG agenda,’ he added. ‘We need a definitive answer as to whether there would be legitimate grounds for industrial dispute by means of GP non-engagement with CCGs.’

Other members stopped short of demanding a boycott, but pressed for renewed debate.

Dr Kailash Chand, who led calls earlier this summer for the BMA to consider boycotting commissioning in response to the pension reforms, and has since been elected as the association’s deputy chair, wrote: ‘The entire concept of CCGs is fundamentally flawed.

‘The BMA/GPC needs to proactively formulate a policy to safeguard not only its members’ interests, but [those] of patients as well.’

Dr Helena McKeown, a BMA and GPC council member who recently quit as an RCGP commissioning champion in protest against what she called ‘covert rationing’, backed ‘an all-out publicity campaign with … a public-facing ethical basis’.

GPC chair Dr Laurence Buckman responded by predicting ‘CCGs will turn into worse monsters than PCTs’, but played down the prospects of a boycott.

‘Most GPs will ignore [clinical commissioning] and just dump it in the “annoying box”,’ he said. ‘They simply don’t care as long as they can do their job and take home enough pay.

‘I fear that the public will blame GPs for the mess that will result from a shrinking health economy but my campaign would major on that. Not doomsaying, not trying to get most GPs to refuse to co-operate with the whole enterprise … but facing the profession and the public and warning them what might happen and what the BMA can do to change it.’

‘I know we agreed about analysis but not tactics up to now. I believe the gloves are coming off but we need to convince 32,000 GPs that now is the time to act.’

Pulse approached each of the contributors to the email discussion for comment. While each of the doctors that responded expressed surprise that we had been given copies of the emails, none denied their authenticity.

When Pulse asked Dr Chand about the leaked emails, he declined to speculate how a boycott of commissioning could be staged, but said: ‘Something has to be done, because it is harming patient care. Everything is still on the table.’