Divide and Conquer

(For some of these links you may need to subscribe to Pulse magazine.)

Andrew Lansley may want to go down in history as the Dr Beeching of the NHS, but he is no fool. He knows that the only people that can scupper his plans are GPs. GPs have brought down Health Secretaries in the past and Lansley is determined that this will not happen to him. As always the best course of action is divide and conquer: get your enemies to fight each other so that you do not have to.

So first I see that the NHS champion Dr John Lister is leading a spirited campaign to get the BMA to show some backbone and fight Lansley's plans. Dr Lister has written a detailed reply to the BMA Chair Dr Hamish Meldrum in response to his letter to GPs where he recommends "critical engagement" with Lansley over the NHS White Paper. Dr Lister points out that this is inconsistent with the BMA's anti-privatisation campaign "Look After Our NHS". He goes through, point by point, the BMA's priorities for the NHS and shows how the proposals in the White Paper violates every one. Dr Lister then points out how powerful the BMA is and then pointedly reminds them how

in 1946 the BMA chose badly and wound up on the wrong side of the debate in opposing the launch of the NHS in 1948

However, he then describes how the BMA have since fought hard for the NHS and commends them on this. But he has a warning:

Sadly it seems that the current stance of the BMA could result in the GPs again lining up on the wrong side of the debate, as the current government contemplates the definitive reversal of Bevan’s nationalisation of the hospital network, which laid the groundwork for the NHS.

Dr Lister points out that there are clearly many GPs who oppose the changes proposed by Lansley (and is currently implementing without Parliamentary approval) and that Meldrum's policy of "critical engagement" is more likely to split the opinions of GPs which will be to Lansley's advantage.


Now Pulse goes further and describes the various GP groups fighting each other. The National Association for Primary Care are fully behind Lansley and they even "urge the Government not to dilute its plans"   even though 60% of their members are opposed to GP commissioning.

The NHS Alliance however are

"calling for the Government to shelve its plans to scrap all PCTs by April 2013, claiming that some trusts should be allowed to remain in place, if not permanently, at least until GP commissioning groups have proved themselves capable of taking over"

The Royal College of GPs and the NHS Alliance are consulting their members to see what approach to take, but from their leaders' statements it appears that they regard Lansley's plans to be very risky.


The divide and conquer approach is working, and it appears that Lansley's stooges are the leaders of NAPC who are recklessly pushing hard for Lanley's plans while the BMA's Meldrum and the more cautious doctors' groups are hoping that they could moderate Lansley's plans. However, Dr John Lister highlights the folly of this approach:

There is no sign so far of compromise from Mr Lansley. On the contrary the prospect of pulling the BMA in behind the proposals and splitting the ranks of health workers has strengthened the government’s hand, giving ministers confidence to stand firm, making it more likely that they will discount other opposition from health unions as ‘self-interested’.

It is most unlikely that this stance [of critical engagemwent] will be viewed with much respect by health ministers, who will simply regard it as a strengthening of their position — and an indication that if they keep the pressure on they can get their way with the BMA. And it seems that there is no fall-back position to be adopted if the gamble of “critical engagement” falls flat, and the government presses on with those aspects of the White Paper that the BMA regards as unacceptable.

Perhaps GPs should learn from the trades union movement: united we stand, divided we fall.