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Reforms are stretching the unity of the profession – and the coalition

Andrew Lansley has managed to drive a wedge through general practice, the medical profession more generally… and his own Government

When the BMA holds its Special Representative Meeting next month, we are told ‘absolutely everything’ will be on the table, from an unlikely ringing endorsement of the NHS reforms, to a rejection so complete that chair Dr Hamish Meldrum is forced to resign.

But whether the BMA defies all expectations and gives the health bill a resounding thumbs up, or opts to oppose it in its entirety, the real test for the meeting will be whether it delivers something Dr Meldrum has so far not – unity.

I sense a collective yearning among the medical profession to identify its common ground and establish a line it can rally behind, because currently doctors are falling out in a manner not seen since the days of fundholding.

We’ve already had a couple of rows between grassroots GPs and those running consortia, but that’s nothing compared with what’s coming, as the mutterings over the experimental approaches being taken by some pathfinders grow louder. Just take a look at our forum for a taster.

Then theres the broader split between GPs – who are merely nervous, resentful, but not uniformly hostile to the reforms – and consultants, who appear increasingly agitated at the prospect that they will be marginalised by them.

It’s no wonder Dr Meldrum has found it so difficult to steer a steady course through this mess, and it’s maybe a tad harsh to place him in the same category as his predecessor Mr James Johnson, whose crime was to fail to properly oppose the much more universally hated MTAS.

Nor is Dr Meldrum exactly alone in the BMA in being wrong-footed by the sharp shift of medical opinion away from the NHS reforms in recent months.

Dr Laurence Buckman too has seemed reluctant to unleash his trademark freeform verbal pummeling for fear of upsetting the commissioning enthusiasts in his ranks. My guess is that Dr Meldrum won’t be the only one told to toughen up his act come the SRM.

Still, it’s hardly as though the coalition Government is all one big happy family on the NHS reforms either. I chatted to one GP leader this week who swore blind that they’d detected more than the odd sign of doubt in the eyes of Conservative health minister Earl Howe.

Then there’s the Lib Dems. One senior party source suggested to me recently that the health bill could lose the Government the next election on its own.

It’s spring conference season coming up, there’s likely to be a motion put down by the party’s health minister Paul Burstow endorsing the reforms, and it’s not impossible that he’ll be told where to shove it.

General practice, the medical profession, the Government, and both its coalition partners – these NHS reforms have split them all.

Richard Hoey, Pulse editor