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This is what defeat looks like

Rarely has a retreat felt so momentous – and rarely has it prompted such white-hot anger.

When the BMA announced two weeks ago that it had suspended plans for any further industrial action over the Government’s pensions reforms, the response from readers was immediate.

‘Capitulationism!’ cried one. ‘The BMA is a spineless, castrated body,’ declared another. ‘What a damp lettuce our union is,’ thundered a third, somewhat mystifyingly.

Another GP gave a more considered overview.

‘And so we retire to a dark corner with our tail between our legs to lick our wounds,’ he wrote. ‘No matter what the rhetoric says, the message we are giving the Government is clear. We have lost the war. Feel free to hit us even harder next time.’

The extent to which the BMA really had lost the war became more apparent on Monday, when Pulse revealed that the Government was to take a back seat in any further negotiations on the planned hike in pension contributions due to come in next year – and instead leave it to the different health unions to thrash it out among themselves.

Last December, the Government’s final tweak to the offer on the table involved sparing NHS workers earning less than £26,000 a year an increase in contributions, with GPs and other high earners picking up the tab with an even steeper hike. Now ministers have said they will only consider amending that deal if all health unions sign up to an alternative within the same cost envelope – a prospect that seems remote.

As Dr David Bailey, deputy chair of the BMA pensions committee, put it, the Government is ‘trying to play one union off against the other’.

The reality is though, that having called the first industrial action by doctors in a generation, and then with no meaningful progress having suspended it, the BMA is short on options.

Writing exclusively for Pulse this week, new BMA chair Dr Mark Porter offered a spirited and straightforward defence of the decision to suspend action. After ‘carefully considering the impact of the action on 21 June’, he said, BMA Council decided a repeat ‘would probably not have the same level impact’. Given that impact was limited at best – between a quarter and a third of doctors took part – that was clearly a non-starter.

BMA Council instead considered whether to suspend industrial action or to escalate it into a full-blown strike, and after a protracted debate opted to suspend action. It was a vote that was far from unanimous.

The big question for many GPs, of course, is why the BMA didn’t consider other forms of industrial action, and in particular a boycott of commissioning. It was a question tackled head-on by Dr Porter, who argued that withdrawing from CCGs was a form of action only open to a minority of BMA members, GPs in England, and claimed that in any case ‘there is a strong argument that it would not have influenced the Government and would even have proved counterproductive, creating opportunities for the private sector to become more involved’.

That won’t satisfy all the BMA’s detractors, of course, and in fact the association’s reluctance to link commissioning with pensions may be a little more nuanced. Whether boycotting CCGs would have had any meaningful impact is open to debate, but what it certainly would have done is inextricably tie the BMA’s principled opposition to the NHS reforms with doctors’ narrow self-interest. There are those who see the BMA exclusively as a terms-and-conditions trade union for whom that might have been no bad thing, but it would clearly have been a defining, and risky, step.

Could doctors’ leaders have handled the earlier stages of the dispute differently? Undoubtedly. But now the BMA is where it is – and the harsh reality for its grassroots critics is that it is largely there because of its members. One GP’s take on the climbdown was to compare the BMA to the Grand Old Duke of York – it had marched its troops to the top of the hill and it marched them down again – but that’s not quite accurate. It could certainly be argued that the BMA asked its members to march to the top of the hill, found only a third followed, and therefore decided on balance against further mountaineering.

This, unfortunately, is what defeat looks like. Both the BMA and the wider medical profession have expended a serious amount of political capital, to very little effect. GPs are rightly angry – but whether the situation they now find themselves in can simply be blamed on poor leadership is a much harder question.

Steve Nowottny is acting editor of Pulse. You can follow him on Twitter at @stevenowottny.