Editorial - Beware of waging an all-out war on NHS reforms

At next week's special representative meeting on 15 March, BMA members will vote on the stance the profession should take to get its views on the government's NHS reforms across.

There is no doubt that, despite GPs' willingness to organise themselves into commissioning consortia, with pathfinder groups now covering around two thirds of England's population, the profession remains hugely concerned about the changes the government is planning.

This week, GP reports on a BMA poll of more than 1,600 doctors, which found that most believe the changes carry more risks than benefits for the NHS.

Ahead of next week's meeting, there is a school of thought that all-out opposition to the Health Bill is the only way ahead, and some doctors may go as far as voting for strike action.

But GP also reports this week on the belief among many leaders of organisations representing GPs that it would be better to stick to constructive engagement and to build on positive elements of the reforms, such as increased clinical leadership.

Many in the profession have been frustrated at the perceived reluctance of the BMA to speak out against the government's plans.

But the BMA has lived up to its pledge to speak out more firmly once details of the Health Bill were made public. There are signs too that Andrew Lansley will not stick rigidly to the reforms as they stand. Warnings about the dangers of price competition have brought DoH promises that this is not the way the NHS will go.

But pressure on the DoH has come not just through loud public statements, it has also come in meetings behind closed doors.

If the votes at the special representative meeting undermine BMA leaders' freedom to engage in these discussions, the reforms may not stop, but simply evolve in ways doctors don't want.

The meeting must send a strong message, but doctors should think carefully before moving to all-out war.

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