It has been a terrible year for doctors, and they made their feelings all too clear at the British Medical Association's annual representative meeting. Lyn Whitfield had her finger on the pulse

It has been a terrible year for doctors. Dr Ian Bogle, chair of the British Medical Association council, acknowledged as much as he opened the BMA's annual representative meeting last week.

Bristol, Alder Hey, Harold Shipman, Rodney Ledward. Each scandal has buffeted the profession and dented its formerly unassailable public image.

Which may be why Dr Bogle went for an upbeat opening to his keynote speech. 'Earlier this month, the government published the results of the biggest ever survey of public opinion about the NHS, ' he said. 'And what did it show? The public want more doctors.

'In every opinion poll I have ever seen, ' Dr Bogle continued, 'who comes out top as the most trusted and respected profession? Doctors.' This was greeted by cries of 'hear, hear', from the 500 doctors gathered in London's Queen Elizabeth II conference centre.

'And who comes out bottom?'

'Politicians, politicians, ' came the chorus. 'Yes, politicians, ' said Dr Bogle to prolonged applause.

Since the public trusted doctors, the government should trust doctors, Dr Bogle went on.

Doctors cared about patients and the NHS and so were prepared to stand firm against 'untried and untested reforms' and the 'worst excesses of government spin'. They were also prepared to launch their own review of what the NHS should do and how it should be paid for, because they were 'not afraid to face up to reality'.

Unfortunately for the BMA, one of the realities it has to face up to is that Dr Shipman, Mr Ledward and the rest have given impetus to demands for medical accountability. And some of its members are less than entirely happy with the systems of revalidation and discipline proposed as a result.

At their own 'craft conference' before last week's ARM, consultants passed a vote of no-confidence in the General Medical Council, which recently issued its own revalidation plans for public consultation. The GPs, meeting in Manchester a week later, were only slightly less critical of the GMC, which is widely seen outside the profession as 'soft' on doctors.

Dr Bogle's speech negotiated a fine line between the two competing demands - welcoming change for a public and ministers determined to have it, while sounding tough on the details for a membership feeling battered by scandal and change.

In a heartfelt moment, Dr Bogle, a third-generation GP from Liverpool, said the case of Harold Shipman, the Hyde GP convicted of murdering 15 patients, 'will haunt me forever'.

But he said Dr Shipman, not the medical profession, had been on trial and the case should not be used to brand all doctors or force through unacceptable reform.

The point was taken up by Dr John Chisholm, chair of the BMA's GP committee, who called Dr Shipman a 'callous and evil man who happened to be a doctor'.

And Dr Peter Hawker, chair of the BMA's central consultants and specialists committee, hammered the point home. Referring to the Ritchie report into Rodney Ledward, he said there was 'justified press and public fury at the actions of that arrogant, incompetent doctor'.

But this was 'likely to swamp the dedicated efforts of the majority - the massive majority - of our senior colleagues'.

The BMA, he said, was determined to 'mount a robust defence of our craft, our profession' in the face of the onslaught, but this was not helped by 'damaging and hurtful allegations' that consultants were 'against revalidation'.

Consultants had led the debate on revalidation and linking it to appraisal, he said, going on to dismiss claims that GPs and consultants were split over calls for a vote of no confidence in the GMC as 'not true'.

Thursday's debate on the no-confidence motion suggested Dr Hawker was right. Although GPs had put forward a milder motion, calling for the GMC to speed up its procedures and take steps to 'regain public confidence', doctors were united in condemning the regulatory body.

The split was between those who supported the no-confidence wording and those who warned it would be seen as calling for the abolition of the GMC. There were repeated warnings that if the GMC went, professional selfregulation would go with it .

Dr Andy Ashworth, an armed forces doctor, described the words 'no confidence' as 'the shortest suicide note in history' and warned that doctors risked putting themselves into the hands of 'Tony Blair and Sir Humphrey ' .

But Dr Charles Saunders, a public health doctor, said the GMC 'had not just had a bad year, or even a bad decade' but had not been well 'for a long time'.

And Dr Hawker said that trying not to mention the words 'no confidence' for fear of the media or the government was like Basil Fawlty saying 'don't mention the war'.

The no confidence motion was passed - hemmed around by amendments supporting self-regulation and calls for the GMC to reform in consultation with the profession.

But the GMC was not the doctors' only focus of attack. Caught between the government's welcome promise of more money for the NHS and the national plan telling them how it will be spent, disgruntled and suspicious medics complained endlessly about 'spin doctors' .

The mood was captured by the motions put forward for the function, structure and funding of the NHS debate on the first morning of the four-day ARM.

Warrington division said: ' T h e prime minister must stop his NHS sound bites and . . . work with the lead NHS profession - ie doctors - for sound NHS future policies for more cost-effective patient services.'

Portsmouth and South East Hampshire division called for the money to be spent on 'delivering evidence-based clinical care and not on politically inspired or consumerist initiatives'.

But at a lunchtime press conference, Dr Bogle downplayed the anger, pointing out that a motion of no confidence in the government had been lost with very little debate and that such sentiments 'are not unusual at a gathering like this'.

As he himself acknowledged, the BMA's leaders shouldn't be too critical of government when the BMA is firmly locked into its modernisation action team process. 'We do not want to be too cynical because I have waited 13 years to be asked, ' he said.' Whether the government delivers is another matter.'