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A huge divide at the centre of general practice

Political editor Ian Quinn gives a glimpse into the extraordinary scenes behind the BMA's Special Representative Meeting this week.

Behind the scenes at last week's Special Representative Meeting there were some bruising encounters between the different factions of the BMA, reflecting the huge divide the coalition's reforms has opened up between grassroots GPs.

Emotions were running high on both sides. There were harsh words, even tears.

While there were also moments of unity, the extraordinary conference came down to a fight not so much with the health secretary but between the BMA leadership and its supporters - between those who fear isolation if they cut off negotiations with the Government and those who have come to the conclusion that talking is pointless with someone who doesn't want to listen.

A vote for all-out BMA opposition to the health bill could have delivered not just a bloody nose but potentially a knockout blow to an already under-pressure Andrew Lansley. But ultimately, delegates stopped well short, despite moments when it looked like full-scale confrontation might be on the cards.

By the time of the crucial vote, there was a sense the rebels were all punched out, while the applause for those calling for active engagement grew noticeably louder.

An early motion calling for the Government to withdraw the bill will result in nothing more than one day's negative headlines, rather than actually force any sort of substantial changes to the legislation, let alone its withdrawal.

In the meantime thousands of GPs across the country are busy leading changes on the ground which many support, though perhaps not as vocally as the opponents.

Now we will see if it is really possible for the BMA and others, not least the Liberal Democrats, to change the course of history by the power of negotiation rather than through confrontation.

Ian Quinn is political editor at Pulse

Ian Quinn SRM coverage

Click here for more coverage from the BMA's Special Representative Meeting on the NHS reforms