It is not just the government that finds the British Medical Association out of touch and stuck in its ways.

A confidential staff survey at the doctors' trade union leaked to HSJ has delivered an excoriating verdict on its leadership, honesty and openness.

In a moment of schadenfreude for the Department of Health, the BMA staff's own union, locked in a bitter pay dispute, has accused the doctors' representatives of trying to impose a performance pay system they would never accept for their own members.

The rights and wrongs of the pay row are an internal matter, but the fact that the BMA leadership has lost the confidence of its own staff has wider ramifications.

It is a measure of the degree to which the BMA has become synonymous with defending the status quo that only a handful of its employees believe the association embraces change or is open to ideas.

If those who work in its culture find it closed and reactionary, it is no wonder that politicians and significant portions of the media are beginning to question its actions and motives.

But at least the BMA's senior managers have had the courage to seek the views of staff and are taking the withering criticisms seriously. It now needs to open its mind to alternative views and engage more constructively in debate over reforming the health service if it is to retain its respect and influence.