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BMA must soften reforms’ hard edges

The BMA may be unable to alter the speed of the Government's NHS reforms, but there are still areas where it can wring out concessions for GPs.

It was third time lucky. Twice BMA Council had voted down proposals for a Special Representative Meeting, but last week its members relented in the face of mounting pressure. Even GPs who support health secretary Andrew Lansley's NHS reforms wanted the opportunity to debate them.

The BMA may come to regret delaying, as ministers race to embed their reforms in the run-up to the March meeting. This Government is expert at keeping opponents off balance through the hyperactive pace of its policy making. Still, the SRM may be overdue, but BMA leaders are determined it will not be toothless. Dr Steve Hajioff, chair of the BMA's representative body, insists ‘absolutely everything' is on the table, including strike action.

A few months ago, a vote among GPs on the NHS reforms would have been hard to call – but Pulse's tracking polls have showed hardening opposition. This week, the RCGP released the largest test of GP opinion since the white paper, with 1,800 members providing resounding support for chair Dr Clare Gerada's sceptical stance. More than 60% of GPs opposed the main thrust of the health bill, with many believing the reforms, which will cost up to £1.45bn, would bring no benefits for patient care. If those concerns are mirrored at the SRM, expect it to deliver Mr Lansley one almighty bloody nose.

Dr Hajioff has suggested nine potential areas for the SRM to debate. Essentially, though, they can be condensed to two touchstone issues. The first surrounds the Government's expansion of the NHS market. The second is GP commissioning itself – not because of a lack of desire to lead the NHS, but because of concern doing so as commissioners could be inherently compromising to the GP role.

There are sound reasons to oppose the NHS market as Mr Lansley proposes. In a true open market, GP commissioners would not be allowed to work co-operatively with specialists. The BMA fears any willing provider will fragment care, by splintering GP referrals across a multitude of small providers. And there's evidence price competition will indeed send prices, but also quality, tumbling down. The BMA will surely set down its opposition, but must also recognise the limits of its power. The NHS market is big-ticket stuff, decided not at BMA meetings but general elections, and both coalition parties supported it in their manifestos. Doctors' leaders must focus on pragmatic adjustments to the policy, particularly to ensure GPs can continue working with specialists as colleagues.

But there is an equally important point of principle on GP commissioning itself.

Mr Lansley, in his health bill, sets out why he believes it will work – by allying ‘financial and clinical accountability'. Yet it is this that leaves GPs so horribly exposed, responsible for rationing, but torn between conflicting loyalties to budget and patient. The BMA must demand GPs get a helping hand. At the very least, it must insist on restoration of the rationing powers of NICE.