Many of the representatives at this year's LMCs Conference appeared ready to up stethoscopes and march on Whitehall to challenge DoH policies, such as access and private providers, as well as the lack of proper evidence to support the primary care White Paper.
Indeed, GPC chairman Dr Hamish Meldrum threw down a latex gauntlet to ministers calling for a slowdown in NHS change, dialogue and incentives with regard to commissioning, investment in premises and central support for flexible careers.
Ministers' comments on access, GPs' so-called over-performance in the quality framework and the push for more APMS coupled with the lack of even inflationary uplifts this year, left the mood of the conference hostile to government policy.
Yet there was a recognition that protest without positive action and proactive solutions was no longer an option. As Dr Meldrum warned the conference, new GMS won GPs the right to say 'no', but not the right to stop others saying 'yes'. If GPs do not take on new services or meet the challenges set by government policy, the reality is that ministers and managers will turn to other providers.
The need for diplomacy and a strong working relationship with ministers and managers was recognised by the conference in its decision not to vote on a motion of no confidence in health secretary Patricia Hewitt and in the applause given to Lord Warner despite comments that had clearly raised hackles among representatives.
However, for Dr Meldrum and his fellow negotiators, there is a careful balancing act in the next few months as they attempt to ensure the DoH listens to GPs' expertise, even when it opposes policy and to negotiate suitable solutions and safeguards for GPs while expressing their anger and frustration. Only a profession that is willing to offer solutions as well as criticisms will give them the strength to ensure it survives and prospers.