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BMJ 1999; 319 doi: (Published 10 July 1999) Cite this as: BMJ 1999;319:128

BMA chairman warns of fight ahead

News p 74

The chairman of the BMA council has warned that the BMA faces a real fight—a challenge—to raise morale and restore professional control “undermined and eroded by the nature and pace of NHS structural change.”

Addressing the BMA's annual representative meeting in Belfast this week, Dr Ian Bogle pointed out that in the latest upheaval the purchaser-provider split had been retained and competition replaced with cooperation. The cash limited unified budget was now reality, and priority setting, or as he preferred, rationing, was now firmly on every local healthcare agenda. Health authorities and health boards were expected to develop health improvement programmes, but, inexplicably, the commissioning process in England and Wales excluded any input from hospital consultants.

Dr Bogle, who was addressing the meeting for the first time as chairman of council, said that these changes, together with NHS Direct and walk in clinics, were making doctors apprehensive and fearful for their future. The pace of change was frightening and he called on the prime minister to “slow down, evaluate changes before moving on, pilot them wherever possible.” And doctors should ask themselves whether they were ready structurally, managerially, and emotionally to progress to primary care trust status.

“We don't want spin with a grin”

The council chairman criticised the fact that the profession learnt about initiatives, such as walk in clinics, from the media. “We don't want spin with a grin. We have perfectly good negotiating arrangements that would allow serious discussion of any proposals or initiatives.” Walk in clinics might pander to the demand for 24 hour access to the NHS, but would they relieve pressure on an understaffed and underresourced service?

Because of the obsession with waiting list targets, hospital doctors were working at greater intensity than ever before, and the attempt to achieve 100% bed occupancy would be a major contributory …

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