Four months into his three-year term as BMA chairman, Dr Mark Porter admits that his introduction to the role has been a baptism of fire.
Elected a week after BMA members took part in industrial action for the first time in almost 40 years, Dr Porter has faced simultaneous battles on issues including pensions, NHS reform, funding cuts and pay.
To add to the fun, revalidation was introduced on his watch. 'It is extraordinarily intense,' he says.
The role of chairman was not one he actively coveted. 'In some ways, quite genuinely, I can say I never wanted it. I have a full-time job that I enjoy somewhere else.'
Each of his BMA roles - chairman of the junior doctors committee in 1997, chairman of the consultants committee in 2009, and now chairman of council - began with somebody suggesting the job to him.
In each case, he says, his initial response was: 'No way.'
After succeeding Yorkshire GP Dr Hamish Meldrum, Dr Porter is keen to make clear that his 14 years on the BMA council have afforded him exposure to 'a lot of primary care issues'.
'It is not that I am some consultant who has been parachuted in with no prior knowledge (of primary care),' he says.
It's the economy
Dr Porter says the government's assertion that 'the money is running out' is a theme that runs right across pension cuts, the Health Act and pay settlements for doctors, including the proposed GP contract changes (GP, 7 November). The thinking has been: 'Let's reform the NHS, let's freeze and cut pay, let's freeze and cut pensions, because that is the only way we can cope with it,' he says.
But he is clear that the government could choose to act differently: 'Quite clearly, this country is richer than it was ten years ago, despite the economic recession.'
Dr Porter admits, however, that tight Treasury control means health secretaries have less room for manoeuvre than they might like.
He describes health secretary Jeremy Hunt as personable, engaging and someone with a vision for the NHS. But he says Mr Hunt has yet to get a handle on the DH.
'GPs' contract, for example, was not on his list of priorities, but nevertheless, it is happening. We need to make sure he understands the potential consequences of things his officials or ministers are doing.'
Asked if he backs the GPC negotiators after the breakdown of GP contract talks, he says: 'Yes, of course I do. There aren't any of them I wouldn't trust to negotiate on my personal behalf, were I a GP.'
The extra workload involved in planned changes to the GMS contract could leave GPs unable to take part in commissioning, he fears.
'I would be particularly concerned that GPs from next year are going to be able to do very little other than focus on the rather damaging provisions within the new contract.'
Asked whether GPs should be balloted about industrial action to protest against contract changes, he says: 'It is always one of the options open to a profession whose negotiations are treated in - I think it is fair to call it - a cavalier manner. We are trying to engage and negotiate and it is difficult to get the other side to keep engaged with us.'
It has also been tough to champion doctors' cause on pensions, Dr Porter admits. 'There is relatively little sympathy when you get down to talking about pounds and pence with MPs,' he says.
Giving evidence in parliament, he heard 'astonishing views expressed by some MPs', who seemed to believe that 'as long as doctors were going to end up with a living wage, you can treat them as unfairly as you like'.
Unlike his deputy, retired Greater Manchester GP Dr Kailash Chand, Dr Porter does not favour withdrawal from GP commissioning in England in opposition to the Health Act.
'It feels rather like cutting your nose off to spite your face. It is a very difficult situation because one is always looking for a way to strongly express real and genuine concerns about the dangers of legislation. But to say we are not playing any more and walk away could cause more damage,' he says.
He says the BMA is still 'looking at a variety of things' to show its opposition to the Health Act, including a pledge card for patients to raise awareness about the 'increasing commercial penetration of the NHS'. Among his greatest fears about the reforms is that 'after a couple of years, they think of a new one'.
|Who is Dr Mark Porter?|
Despite a growing gap between NHS systems in different UK countries - including the possibility of a breakaway GP contract for Scotland - Dr Porter is confident the BMA can continue to represent all members.
'The BMA has demonstrated over the past few years that it is able to take part in talks with devolved negotiations up to and including separate contracts and it is never something we would rule out,' he says. 'It is something we have grown used to working with in the BMA.'
These are challenging times for doctors and for the BMA, Dr Porter admits. He will continue to knock on the health secretary's door and says ministers do listen to the BMA.
Getting them to act, however, can prove more challenging. Dr Porter has two years and eight months to get his message across.