Wednesday, 3.15pm

During the debate on out-of-hours care Dr John O’Driscoll makes an allegation about one particular provider that might have what are euphemistically known as “legal implications.”

I won’t repeat it here – not because I want to keep you in the dark, you understand, I just don’t want to end up in court because I haven’t checked my facts. Suffice it to say that either this provider has done something very bad indeed, or the BMA has got itself in hot water. Watch this space.

Which seems a good note to end on. I’m off back to London. That’s all, folks.

Wednesday, 3pm

Buckman’s speech hits all the notes one would expect: commercialization’s a threat, the patient survey is biased, MPIG isn’t going anywhere. It’s something of a greatest hits compilation, but the repeated interruptions for applause suggests it goes down well.

More interesting are the debates that follow. First up some consultants slam referral incentive schemes. “It’s like a manager entering the theatre and throwing a spanner into the operation site!” says Dr Zorha Banu.

Conference agrees.

Then Dr Michelle Drage stands up to despair that conference even needs to consider a motion describing partnerships as the “gold standard”. Practices need more incentives to take on partners, she says, because they’re not doing it at the moment. “In the whole of London last year, there was just one vacancy!” she cries.

Conference loves this, and overwhelmingly backs the motion demanding the BMA do more.

Afterwards, while I talk briefly with Dr Drage in the corridor, four different GPs thank her for the speech.

Wednesday, 12.30pm

And then it’s the ethics debate. Lots of fascinating debate here, followed in every case by taking the least controversial path possible.

First up is prayer. “The NHS was founded on Christian principles,” the Christian Medical Fellowship’s Dr Bernadette Birtwhistle tells us. Audible bristling of Jewish/Muslim/secular doctors. This, I suspect, is the point where she loses all chance of winning the vote.

Next it’s a motion claiming that TV advertising of abortion promotes sex as a “values-free activity.” Medico-legal committee chair Dr Jan Wise gives us an anthropological world tour (“In Senegal 90 per cent of woman have children before they’re 18!”) to attack the notion of values.

“I’m talking about broad based, common sense values,” says proposer Mark Pickering, to muted boos. This is voted down too.

And finally, euthanasia. This is, if anything, the most contentious debate yet. Everyone speaks with passion whether pro (“Why when it comes to death do we have a collective outbreak of hubris?” – Dr Jacky Davis) or anti (“The vast majority would lose the protection the law now gives them!” – Dr Helen Grote).

It’s close – nearly 50:50, so I suspect it’ll be back – but in the end the motion falls.

Wednesday, 11.50am

Dr Nagpaul is talking patient surveys.

“Only the government could see an 88 per cent approval rating as a problem rather than something to be triumphant about,” he’s saying.

I imagine Laurence Buckman will come back to that one in his speech this afternoon, don’t you?

Wednesday, 11.30am

Bright and early this morning came the ever exciting debate on IT. Dr Clive Peedell came armed with an ancient issue of Computer Week, which included a diagram showing NPfIT as a series of pillars supporting payment by results. The implication, he said, was that the programme exists entirely to support the marketisation agenda. “That is why we’ve got a £13 billion waste of money!” he thundered.

Conference loved that one.

Next up was confidentiality, including a brief spat between the surgeons, who pointed out that it can be helpful to know stuff about their patients, and the GPs, who like to think of themselves as the defended of patient records. “If there’s something I don’t want to be shared,” said Grant Ingrams, through gritted teeth, “I don’t want it to be shared when I’m unconscious.”

The GPs win the day.

 

Wednesday, 10.45am

“Some people say,” Tony Calland is saying, “that the BMA is a weak trade union with no influence on policy…”

A roomful of newspaper hacks nod vigorously.

 

Tuesday, 1.15pm

Other subjects to come up this morning: PFI (bad, expensive), health visitors (good, in short supply), consultant-to-consultant referrals (good or bad, depending on how well behaved your PCT is). There was also a rather lively debate on whether the BMA should cut its ties with overseas medical associations that don’t campaign against political oppression (“I think we take freedom of speech rather for granted in this country,” mused Dr John O’Driscoll).

As I write, the BMA’s senior staff have all donned rather fetching “Look After Our NHS” t-shirts, in preparation for a photoshoot. With that, the public element of the conference has wrapped up for the day, and will resume tomorrow morning.

Tuesday, 12.30pm

Not altogether surprisingly, the BMA has voted to nationalize the health service.

This, briefly, looked like it might be contentious. A tranche of GPs, led by BADGER’s own Dr Fay Wilson, stood up in protest at a perceived threat to independent contractor status. In Birmingham’s swine flu epidemic, she noted, “I was the only one who wasn’t nationalized and I was the only one talking the truth!”

But Hamish Meldrum told the room that GPs’ unique status had been enshrined by Nye Bevan in 1948, so everything would be peachy. The motion passed.

Tuesday, 11.30am

One of the morning’s more lively debates was on the question of whether asylum seekers should have free access to NHS services. Helen Preston, a rather idealistic medical student, argued that refusing treatment ran contrary to the core principles of the NHS. The current system, she said, was neither safe (infectious diseases can spread untreated) nor cost-effective (asylum seekers only end up in A&E anyway). Better, surely, to let them see a nice, value-for-money GP.

This all got my esteemed colleagues from certain tabloid newspapers rather excited.

But, alas, Dr Terry John of the international committee pointed out that, as worded, the motion would mean giving asylum seekers access to elective care as well as emergency care. That’s way beyond anything they’ve asked for before.

Only half the motion passed. The BMA’s position now seems, basically, to be that it’s a great shame asylum seekers don’t get better care, but not so great a shame that they should go special treatment. “So, no story then,” a tabloid hack said, rather mournfully.

 

Tuesday, 9.50am

Last night, by the way, the ARM
debated the vexed issues of regulation and revalidation. On the latter
there’s a fair amount of consensus – it’s okay in theory, but there’s a
lingering suspicion the government will spectactularly screw it up. One
doctor warned of a situation in which “half the profession are
constantly revalidating the other half.”

Rather more contentious
was the debate on the role of the GMC. There’s a widespread feeling
that the move away from self-regulation, and towards an unelected,
largely lay, council, has emasculated the medical world. “We are no
longer a profession,” says Dr Peter Joliffe. “Wwe have been relegated
to the status of a trade!”

So, if the profession isn’t regulating itself, why should it pay for the GMC? Shouldn’t the government stump up?

No,
says Hamish Meldrum. The profession still has plenty of influence. If
it isn’t willing to put in a few quid, it might lose its veto.

Conference duly votes that the GMC’s fees are too expensive. But it will grudgingly keep paying the blasted things.

 

Tuesday, 9.30am

Tuesday morning begins with Dr Andrew Dearden on his specialist subject of pensions. He points out that more money has gone into the fund than has been taken out; that pensions are deferred pay, and the DDRB sets funding accordingly; that if the government attempts to say otherwise it’s got a fight on its hands…

If all this sounds just a teensy bit familiar, it’s because it’s the same speech he gave to the LMCs three weeks ago. Word for word. I guess he means it.

Monday, 4pm

By the narrowest of narrow margins, the ARM has rejected a motion calling for retired doctors to have the “same prescribing rights as current doctors working in non-clinical fields.”

A certain amount of controversy over this one. The argument against is that, after retirement, a doctor’s knowledge will quickly become out of date. On the other hand, if they’re good enough to be drafted into the fight against swine flu, why aren’t they good enough to write the odd scrip?

Despite impassioned calls by Dr Frank Wells, former Retired Members Forum chair, the motion fell, by 48 per cent to 46 per cent. With the numbers that close, I suspect we haven’t heard the last of this one.

 

Monday, 3pm

For all the rage, for all the speeches, for all the familiar sounding claim that “we have 24 hours to save the NHS”, the BMA will not strike against privatization. This is a shame, if you’re a headline-hungry hack like me, but probably a good thing if you’re just about anyone else.

Dr Keith Brent, with a passion to rival anything said about the horrors of privatization, announced he would not desert his patients. And despite Dr Jacky Davis’s claims that a day of action was better than an eternity of private care, the room was with him.

The BMA won’t be organizing a march in favour of a publicly funded NHS, either. A majority actually backed this one – but not the two-thirds majority it required to pass. Instead it scaped by with just 54 per cent of the vote.

“We didn’t have time to vote!” someone yells. “Re run it!”

And so the vote is re-run. And once again, just 54 per cent say aye.

So, it’s more information campaigns, and more wars of words. No actual action will be taken.

 

Monday, 2.40pm

One of the things that never ceases to amaze about BMA conferences is the things the profession can find to disagree about.

A couple of hours ago, the ARM passed a motion calling for the abolition of the £7.20 prescription charge that applies to patients in England (but soon, rather unfairly, won’t apply in the rest of the UK). The motion carried almost unanimously.

Almost, but not quite. One – Scottish – doctor spoke against it, on the grounds it could lead to demand spikes and patients who basically don’t know they’re born. (Why this isn’t a problem for the rest of a free-at-the-point-of-delivery NHS isn’t exactly clear.)

Earlier that day Wales’ Dr Andrew Dearden proposed a motion arguing that patient care should come before money or targets. And, yes, someone had a problem with that too.

“It’s the essence of medicine. It doesn’t need re-enforcing,” said medical student Parviz Lakha. “It’s patronizing.” “But we can’t reject a motion saying we put patients first,” pleaded Dr Dearden.

The motion carried, of course. Dearden claimed to be baffled anyone had spoken against it.

 

Monday, 12:30pm

Laurence Buckman is having a good shout about commissioning. “Of course it should be led by the private sector,” he’s saying. “Public sector!” he corrects hastily, to loud boos. “Freudian slip there. Just checking you’re awake.”

The subject of this particular rant is world class commissioning. “What an Orwellian term,” he says. “Of course it’s world class. Noone else is stupid enough to do it.” When the chair points out he’s out of time, the room calls for more. And more he gives us (“World class commissioning? World class con trick more like”).

This speech chimes well with the mood of the room. The evils of privatization, marketization, targets – the entire post-Milburn health agenda, really – are something of a theme at this year’s ARM. The overwhelming feeling is that it was bad enough throwing money at management consultants and “stimulating the market” in times of plenty; now the money is running out, it’s unforgivable.

So it is that this morning’s session began with Hamish Meldrum warning of the horrors of insurance based medicine (in Australia, beggars wave placards asking for help with their medical bills, apparently). Since then we’ve had Dr George Rae on how the pressure to achieve foundation trust status has put a string of hospitals at risk of repeating the Mid-Staffs scandal; and the GPC’s own Dr Chand Nagpaul on how targets lead to inappropriate referrals and diarrhoea outbreaks.

Luckily, Dr Andrew Mowat has a solution. “If society deems it necessary to revalidate doctors,” he asks, “why not NHS managers? Or even politicians?”

We thought that’s what elections were for. But we like the thought.