Feature

Our doctors are all revolting

The fat cats are fighting back in defence of the NHS, says Alan Walters. But are they just protecting their own cream?

Our doctors are revolting! No, I’m not sucking up to those alternative types, it’s true. All across the country amiable old Dr Cameron’s have been getting irascible enough to hand out leaflets denouncing the government — a Conservative government. And they even rejected a new Tory-type contract, despite their negotiators urging moderation.

Now you might expect such moves from the idealistic Dr Finlays — and of course they are having a good time too — but this sort of behaviour from all doctors stretches professional standards to the limits.

If a Labour government were in power, well, that would be different, but the British Medical Association (BMA) versus the Tories is something of a family row — and a flaming row at that. The doctors have earmarked millions of pounds for publicity to make their point and government ministers have responded spluttering with rage and hastily mounting counter propaganda campaigns of their own.

The argument seems to clear. The BMA says the NHS is underfunded, undermined and under threat — all because of the government. And the GPs say the contract is part of that threat, and so must be rejected. Who would have thought that the BMA, of all fat cat guilds, would have pitched in with such unrivalled energy to defend the NHS ?

In this the pompous, fusty, reactionary old BMA we all knew and loved, reeking of private practice and double standards, preaching that ‘doctor knows best’ whenever medics were challenged? It is.

Things must have changed inside the BMA for such a turnaround, and they have. But they have changed in the outside world even more thanks to Mrs Thatcher, and everything is upside down. The doctors have had 40 years of the NHS, and they see how it works. If the BMA’s change of face means anything, it is simply that he NHS works better and fairer than any other health service, and the doctors know it.

Of course it works better for them too.

There is nothing like a little competition to unsettle the nerves and the income, and the NHS provides the opposite of that — at least for the top guns, the consultants and the GPs.

In most medical thinking, private practice is a good thing, as long as it is based on a firm foundation in the NHS.

Turn everything around, like the NHS white paper does, and the instabilities of commerce might disrupt the certainties of NHS incomes — however much they are underfunded.

So two lines of thinking converge. The NHS is a good thing for the public, and a good thing for the profession, and so needs vigorous defence. But how?

Here the BMA is less sure of its ground. Doctors cannot really go on strike with out allowing the government to do the public shroud-waving.

Various sorts of non co-operative and disobedience are possible, but they are hardly punchy. It looks as if there is no obvious way for the medics to influence a hostile and intransigent government, except through the ballot box.

If the NHS is still a running sore for Conservatism by the time the Cabinet plans its pre-election consumer boom, Tory intransigence will soften. Keeping a campaign going for that length of time — a year, perhaps two — is some task, and the BMA’s political machine may not be up to it.

Nature will out, and the nature of medical professionalism is not so far from the wallet consciousness so carefully identified by health secretary Kenneth Clarke. That is why GPs have become so agitated about their new contract, issued with dire threats of unilateral imposition soon after the white paper itself was launched.

Concessions negotiated by the BMA have not satisfied the backwoodsmen and women who want to fight about technicalities just when the public is angry about broad bush policies that threaten the NHS.

Most of us can grasp the implications of hospitals opting out and GPs taking budgets.

Who knows what an increase from 47 per cent to 60 per cent in the proportion of GP income derived from capitation really means, and who cares ?

Well, the doctors do, since they know best for us we may be taken down their path.

A quarrel between GPs and the government over the meaning of a contract may add one more injury to the current collection of Tory wounds, in which case we can benefit from a collapse of Conservative support and a new government sooner than we bargained. Or we might watch the government impose something really nasty on the family doctors and call the BMA’ s bluff, with immediate consequences for the government’s Rambo rating.

Either way, we, the patients, will have to take the medicine as prescribed. The more things change, the more they stay the same, it seems.