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Meldrum needs to find his voice

Earlier this year, the healthcare world was swept by rumours that health secretary Andrew Lansley could be forced to resign amid fierce opposition to his NHS reforms.

But Mr Lansley is still in post and attempting to restore some lost authority, while it is Dr Hamish Meldrum, chair of the BMA, who is now fighting for his position.

We reveal in this issue that BMA London has formally censured Dr Meldrum for ‘undermining' opposition to Mr Lansley's reforms by calling for the health bill to be modified, rather than scrapped. This is the first time in the history of the BMA's largest regional branch that a sitting BMA chair has been censured, and it represents a vote of no confidence in his leadership.

Dr Meldrum has already had one near-death experience as he has led the BMA rather gingerly through the minefield of its response to the Government's plans. It is widely accepted that had the BMA's special representative meeting voted for all-out opposition, against Dr Meldrum's advice, he would have been forced to quit there and then. He survived another snub to his authority at the annual representative meeting, when delegates ignored his pleas for moderation and called for the revised bill to be withdrawn. He will need to draw on those cat-like qualities once again if he is to slink past this latest threat.

But does Dr Meldrum deserve to be censured? And to what extent does the view of his leadership expressed by BMA London – well known as the organisation's most militant branch – reflect those of GPs and hospital doctors up and down the country? It is the responses to those questions that will determine Dr Meldrum's future prospects, and ultimately shape the stance taken by doctors to Mr Lansley's reforms.

There is no question that Dr Meldrum has had an immensely difficult job. Senior GPs privately admit that the BMA has been enormously split over the Government's proposals, with some stressing divisions between GPs and consultants, and others between moderates and a hard core of anti-privatisation campaigners. Whatever is the source of the greatest division, it is Dr Meldrum who has to bear the strain of leading an organisation that can't agree on what it thinks.

But while it is possible to have sympathy for Dr Meldrum's position, he must take responsibility for a failure to craft a distinctive line on the Government's plans. The BMA has proposed numerous changes to the health bill, but diligent nit-picking is no substitute for a cohesive agreed position and strong statements of policy. How many GPs could explain exactly where the BMA now stands on the proposed revisions to the health bill, and what it believes renders the planned legislation irredeemable?

And while Dr Meldrum was censured over the reforms, he is under increasing pressure too over the BMA's fuzzy position about whether to ballot for industrial action on pensions. The NHS reforms are of passionate interest to politically minded doctors, but if Dr Meldrum doesn't find a robust voice on pensions, he really will feel the wrath of the whole profession.