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BMA’s concern must be detail, not politics

There was something of the whirlwind romance about the coalition's early days in power.

Dashing health secretary Andrew Lansley seduced GPs with a series of beguiling policy announcements – the Department of Health was to review the patient survey, halt top-down reconfigurations and hand GPs power over key financial decisions.

When the health white paper was released, the rush of excitement surrounding the new Government served to soften the shock at the sheer radicalism of its proposals, particularly the plans to scrap PCTs entirely. Early poll results among GPs were much more positive than for comparable policy announcements in recent years – 51% supported the commissioning plans, while 31% opposed them.

But then the summer recess came, the supply of detail from the DH dried up and, in the words of a member of the RCGP council, a vacuum was allowed to develop. Pulse's online forum began to fill with GPs expressing nervousness, or downright opposition, to the commissioning plans.

The scale of the task ahead has gradually dawned on GPs, and the fear of inheriting PCT debts has unnerved them. Those concerns are reflected in a poll in this week's Pulse, finding GP support for commissioning has slipped to 38%, with opposition at 48%. Just 28% believe general practice will be able to commission effectively.

It was in this edgy atmosphere that the BMA met last week, as it attempted to finalise its response to the DH's consultation on the white paper. It must have been a difficult meeting. It is a sign an organisation is struggling to speak with one voice when its members cannot even agree on what they disagreed about. Several said the key moment was a vote that the plans would accelerate privatisation of the NHS. Another dismissed that as the obsession of a band of ‘die-hards' and insisted the core discussion centred around how to make commissioning workable for GPs. In other words, the BMA is still not comfortably reconciled to whether it should be opposing the white paper in principle, or working with the Government to make the plans better in practice.

Health secretary Andrew Lansley is presumably aware of the growing nervousness within general practice, because he has chosen this moment to make a personal appeal to GPs to keep their nerves in check.

He seeks to move the debate on from whether GPs should commission to how soon, encouraging them to begin accessing PCTs' books and to ‘start work now'. His plea presents the BMA with an enormous trial of leadership. It is a group of medical politicians, but it must resist being sucked into a political fight over privatisation, tempting though that might be. Mr Lansley is confident he will get his bill through parliament, and a pragmatist on BMA council admitted ‘it's not a question of whether, it's a question of how'. Given that, the focus must be on securing a deal that makes commissioning survivable for GPs – a deal that's fair on management allowance, debts, incentives and financial risk, and that allows those who are not interested in commissioning to minimise their involvement.

It may not be romantic, but what matters is what will work.

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