As Dr Mark Porter woke up last Friday morning, to begin his first day as the newly elected chair of the BMA, he could have been forgiven for pausing a second, looking in the mirror and wondering what exactly he had got himself into.
Representing the association's 150,000 members is no easy job at the best of times, but these are not the best of times.
The NHS is gearing up for the biggest reorganisation in its history, eye-watering efficiency targets are increasingly forcing doctors into an unpalatable rationing role – and then, of course, there's pensions.
The man Dr Porter is replacing, Dr Hamish Meldrum, drew a standing ovation from delegates at his farewell speech, and rightly so. He has been a distinguished servant of the BMA, and represented doctors with dignity, gravitas and authority over the past five years.
And yet there remain real questions over some of the BMA's recent decisions – questions which will inevitably shape Dr Porter's thoughts as he looks to put his own stamp on the association's strategy.
On the NHS reforms, the policy of ‘critical engagement' initially appeared statesmanlike, but then increasingly exposed as doctors' views on the health bill hardened. Ultimately the policy became more ‘critical' than ‘engagement', but many rank-and-file GPs felt it was too little, too late.
The vote at last week's Annual Representative Meeting instructing the BMA to campaign for the health act to be repealed, against Dr Meldrum's bidding, suggested lingering discontent.
On pensions, the BMA has been much more robust. But with the benefit of hindsight, its refusal to join other health unions in NHS-wide industrial action last November left it exposed when going it alone this year, and its handling of the day of action itself was politically tone-deaf.
The decision to target patient care rather than paperwork was curious, and the BMA invested so much energy in averting a possible legal challenge and running a media campaign to reassure the public that somewhere along the way it forgot to sell the whole idea to its own members.
The result was a lacklustre turnout, which fatally undermined the first industrial action by doctors in a generation – and a nagging fear that on pensions the BMA may have shot its bolt, with nowhere left to go.
All of which adds up to a daunting to-do list for the new BMA chair – and a profession which, in the coming months, will need strong, sure-footed direction.
To have any hope of influencing the NHS reforms, winning concessions on pensions, getting members on side and restoring the BMA's credibility with the Government and the national media, Dr Porter will need to listen carefully, and then lead decisively.
A little luck wouldn't go amiss either.
Not such a clean slate
In December 2010, Pulse readers celebrated a victory for our A Clean Slate campaign, after ministers promised GP commissioners would not be saddled with long-standing PCT debts.
But crucially, the Department of Health only guaranteed legacy debts accrued before April 2011 would be wiped, claiming any debt accumulated subsequently would somehow be cleared by CCGs working in happy collaboration with PCTs.
GPs were doubtful, and now it seems they were right to be so. NHS North Yorkshire and York predicts a £19m debt will be bequeathed to CCGs next April.
Health secretary Andrew Lansley continues to insist all will be well, announcing last week he is ‘still intending for CCGs to start in April 2013 with no legacy debts'. If he has a plan for how that actually might be achieved, now would be a good time to implement it.
