BMA members rather than the organisation itself called a special representative meeting (SRM) on the 15th March 2011, the second in two decades. Dr Hamish Meldrum, the chair of the BMA council, appeared visibly anxious and keen to maintain the unity of the profession. In a professionally delivered speech he struck exactly the right balance between anger (“I do not support this bill. The BMA does not support this bill. The profession does not support this bill”) while remaining in touch with reality (“We need to be realistic about where we are now and what we wish for”).

Initially I was a little disappointed that the BMA pulled back from outright opposition, but now on reflection I feel that we achieved a lot. Pragmatism carried the day. As a critic, in my view we should have avoided the division on motion 175. Most observers will find it a bit odd for the SRM to vote for the Health and Social Care Bill to be withdrawn (motion 35), but not to oppose it outright. Passing the motion for all out BMA opposition to the health bill in my view could have delivered not just a bloody nose but potentially a knockout blow to an already under pressure Andrew Lansley, but it would have given the BMA very little room for manoeuvre.

However, the sentiment of the meeting throughout the day was to oppose clause after clause of the rotten bill. The BMA leaders have stuck their necks out saying they can get the bill modified. That is why they did not actively oppose the motion 175.  Strange logic but I think it had more to do with saving the face of the BMA than thinking about the NHS or patients.  A competitive market is at the heart of Mr Lansley’s whole vision, and regardless of whether one is heartened or horrified by that, trying to tamper it into some sort of hybrid managed market is a recipe for muddle.

Andrew Lansley’s Health and Social Care Bill with its plans to abolish SHAs and PCTs and herd GPs en masse into commissioning consortia represents the most radical reform of the health service since 1948. This reform will impact on all those who deliver and receive NHS services.

For patients it threatens to fragment their care even further and to take the “national” out of the National Health Service. For those delivering care (GPs, consultants, nurses, and all other care professions) it places them at the front line of a reliable institution where we are all prone to amplify the unacceptable – for most this is often our clumsy way of saying that we don’t want our NHS diminished. A significant majority of the BMA believes that the health and social care bill is an attempt at using the market forces of “creative destruction” to fundamentally change how they practice so that quality of care is subjugated by economic austerity.

The question then is where does the British Medical Association now stand after the SRM? The answer has to be that it is on a knife edge between the doctors in hospitals and in GP practices that are at best doubtful about the proposed reforms, and between those who are vehemently against Andrew Lansley’s proposals.

The truth is that the medical profession is exhausted by successive Government NHS reforms – 15 in the last 30 years. These latest reforms will open further the gaps in the pathways of patient care at a time when patient satisfaction with the NHS has never been higher. These “care gaps” are the product of two things: increasingly private sector models of hospital care under the Foundation Trusts and the disassociation of local democratic accountability as the NHS is denationalised. Mr. Lansley’s reforms are a serious threat to healthcare delivery as we know it. Opposition from the
profession is on the increase not least because of the profound effects on their terms & conditions of employment, pensions, medical training and professionalism, but also because they foresee that the knock on effects for patient care will be devastating. Amazingly, the coalition has been getting away with this because there has so far been far too little understanding and resistance from the BMA, which is realistically the only organisation that can prevent this assault on the NHS.

It is really testing time for the BMA’s leadership. The BMA membership needs to hold the BMA leaders to their pledge. I guess the test will be whether there are acceptable amendments to the Bill.

Kailash Chand has been a GP for last 30 years and is now chair of the NHS Trust Tameside &
Glossop. He was on the BMA council and general practitioner’s committee until last year. He was awarded an OBE in 2010 for services to the NHS. He writes for the Guardian, and other regional and national publications on health matters.