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The BMA is walking a tightrope over GP commissioning plans

By Richard Hoey

Critics of health secretary Andrew Lansley's plans are gaining in strength, but doctors' leaders are only beginning to decide which way to jump, says Pulse editor By Richard Hoey

Shadow health secretary Andy Burnham has just warned that the Government's plans for GP commissioning will ‘throw the NHS into chaos', create an ‘unstable free market' and pose the greatest threat to the health service in its history.

But then that's not really a great surprise. Mr Burnham has opposed the shake-up from the start and of course a bit of a row can't do his leadership bid any harm.

What's been noticeable over the last week or so though has been the broad range of critics who have spoken out against Andrew Lansley's plans, and their growing confidence.

Public service union UNISON is launching a legal challenge against the reforms, a Conservative think tank has warned Mr Lansley could be either ‘the great reformer… or the great failure' and the Health Service Journal, with its customary warmth towards general practice, has declared: ‘GPs pose £2bn threat to commissioning budget'.

On the other hand, the NHS Alliance has warned would be a ‘disaster' if GPs did not throw their weight behind commissioning, while the National Association of Primary Care claims to have received ‘widespread reports' of NHS managers deliberately obstructing the reforms.

The rhetoric is being stepped up, but none of the rousing words are as yet coming from the BMA, which is walking the trickiest of tightropes on this one.

GPs may be rather nervous about the plans, but many are also quite excited. Plenty of hospital doctors though are just nervous… and I'm told there's some delicate talks going on behind the scenes between GPs and consultants to try to establish common ground.

The BMA has so far avoided being pinned down, casting itself as above the fray (much to the disgust of some of its members, who want it to oppose the plans). The GPC, however, has no choice but to get its hands dirty, as it prepares to enter talks with the Government.

And we're just starting to see the beginnings of a GPC line emerging, after its rather nondescript response to the white paper.

Negotiators are now saying they do not support Mr Lansley's proposal to write commissioning into the GP contract, which they fear would spell an end to the UK-wide contract and substantially weaken their negotiating hand.

And GPC chair Dr Laurence Buckman has told Pulse he will also oppose any move to dump GP consortia with the debts incurred from Darzi centres and PFI schemes – although rather surprisingly, he is accepting GPs could be lumbered with other historical deficits.

There is a growing sense that the GPC is starting to find its voice, and is steeling itself for a much louder argument over the white paper plans than it has indicated up to now.

As for the wider BMA, expect it to leap off from its tightrope pretty soon. And it may not land on the Government's side.

Consortiums or consortia?

Just a quick note about grammar. We've had a few emails about Pulse's use up to now of consortiums as our chosen plural, rather than consortia.

Both are grammatically acceptable, and it's Pulse's style to avoid Latin plurals wherever possible.

I'm beginning to realise though that this may not be one of those occasions… everyone, from the Department of Health down, has opted to use consortia.

So, rather than Pulse take on the world, we've decided to concede to the will of the masses. Consortia it will be for us from now on.

By Richard Hoey, Pulse editor