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Fallout begins over BMA’s contradictory SRM votes

By Richard Hoey

Motions demanding the Government withdraws the health bill, but against opposing it ‘in its entirety' have left the BMA's position muddled and unclear, says Pulse editor Richard Hoey

At this week's Special Representative Meeting, BMA delegates managed quite a neat trick.

They concluded they were opposed to the health bill as a whole, and therefore that it needed to be withdrawn, but they also decided not to oppose it in its entirety, choosing instead to pressure the Government to modify key sections.

The debate at the SRM was fiercely argued, and both positions have their merits, but that doesn't alter the fact that they're mutually exclusive.

Health secretary Andrew Lansley isn't very likely to jettison his legislation, given that even the organisation asking him to do it has decided it won't do so with any force, and is working on the assumption that it will be ignored.

But if by some miracle he did decide to listen to the first BMA motion and withdraw his bill, it would rather scupper the second BMA policy, which is all about constructively engaging with it. There wouldn't be any bill left for the BMA to engage with.

So why then did a BMA meeting that began with the radical call for the bill to be withdrawn conclude with such prosaic pragmatism?

Partly, I suppose, it may be that representatives lost their nerve. Dr Michelle Drage's intervention, with her suggestion that BMA opposition would drive many more pragmatic GPs into the arms of the National Association of Primary Care, seems to have been a key moment.

The deciding factor though was the position of the BMA's leadership, which had argued that GPs should not call for the bill to be withdrawn, but was even more fervent in urging delegates not to vote for outright opposition.

It was an argument marshalled, and given added passion, by a simple instinct for self-preservation. BMA chair Dr Hamish Meldrum would have struggled to stay in post if the SRM had rejected his engagement strategy, a leading member of the profession told me this week.

Not everyone is impressed by this motivation. One senior BMA representative told me it was ‘truly disgraceful' and insisted the leadership had been more interested in saving face than in crafting a coherent opposition.

At least one GP on our website has already insisted that he has seen enough in the BMA meeting's confused response to be off to the NAPC.

Others think differently. One leading GP told me he thought the contradictory votes could hand Dr Meldrum the perfect negotiating chip.

He has a licence to negotiate with the Government, but he can now insist ministers have to give him something to keep the grassroots happy.

The outcome may be muddled, but at least it leaves everyone, including the Department of Health, on their toes. No-one knows quite what to expect next.

Richard Hoey, Pulse editor