By Gareth Iacobucci
Exclusive: The BMA will put ‘absolutely everything' on the table including strike action when it determines the medical profession's response to the Government's NHS reforms at a Special Representative Meeting next month.
Doctors' leaders have set out a series of demands to ministers they say must be met before they can support the health bill, including amendments to ensure GPs are free to co-operate with hospital specialists and to scrap moves for providers to compete on price.
BMA Council last week bowed to grassroots pressure and agreed to hold an emergency meeting on 15 March, where the association will determine whether it will formally oppose the health bill, and if so what actions it should take.
And in a hardening of its stance, the BMA called for the Government to halt implementation of GP commissioning until legislation has passed through Parliament. Prime Minister David Cameron insisted he was ‘determined' to see the reforms through as the health bill moved to its second reading this week.
The chances of full-on confrontation between doctors and the Government grew with the release of a major survey by the RCGP of nearly 2,000 of its members, finding almost two-thirds opposed the Government's reforms – reflecting the growing opposition found in Pulse's tracker polls.
The SRM will have the same power as the BMA's Annual Representative Meeting to determine negotiating policy. It will address key elements of the Government's plans, including the any willing provider policy, the degree to which GPs will be able to co-operate with hospital specialists under competition rules and whether it is right for GPs to be simultaneously responsible for patient care and budgets.
Dr Steve Hajioff, who will chair the meeting as head of the BMA's Representative Body, told Pulse: ‘Absolutely everything about our response and the way we engage could change, with the bill as a whole and sub-sections. We'll know what members think about competitive tendering, for example, and what they require us to do. That could vary from welcoming something, to doing nothing, to organising a strike ballot. The last is unlikely, but it is possible.'
Dr Hajioff, a GP and public health consultant in south-east London, has suggested in a letter to practices nine key areas for discussion:
• pace and scale of the reforms
• public and patient engagement
• expansion of the market and any willing provider
• price competition and competitive tendering
• regulation and governance
• the future of education and training
• the principle of clinician-led commissioning
• who should and shouldn't be involved in supporting development of commissioning
• the future of public health.
The BMA is demanding GP co-operation with hospital consultants is not only allowed as an option but made mandatory, and wants removal of any enforced requirement by the regulator Monitor for GPs to promote competition when commissioning services.
Last week's BMA Council meeting rejected calls to oppose the bill in its entirety, but the option to debate a similar motion at the SRM remains open.
Dr Helena McKeown, a GP in Salisbury and deputy of the SRM agenda committee, said there had been clear demand for a meeting – with Pulse finding backing even among the reforms' supporters: ‘I've been inundated by members asking how they get to the meeting and how to submit motions.'The BMA's proposed amendments to the bill
• Do not force GP consortia to promote competition between providers
• Rejection of national tariff pricing
• Requirement for GP consortia to involve consultants, public health professionals and the public in commissioning decisions
• Protection for foundation trust staff in relation to NHS terms and conditions and continued NHS employment if the trust is placed in administration
• Protection for the independence of directors of public health as health professionals
• Rebalancing of the bill so that more attention is paid to public health and quality of care
• Maintaining national oversight of medical education and training
• Ensuring the management and planning of the medical workforce is carried out at minimum at national level, and preferably at UK level