COMMENT: Medical posturing and political opportunism imperil the health service

The 'demoralised, disenchanted, dejected' medical profession has been on lavish display this week in Bournemouth. It would be easy to dismiss out of hand the complaints shrieked from the podium at the British Medical Association's annual conference as simply carrying on the great tradition of the BMA's regular July whinge-fest.

Some of it undoubtedly is little more than knee-jerk resistance to change, of the kind which the BMA has always efficiently channelled into the public domain, eerily reminiscent of the war cries against the internal market a dozen years ago - indeed, recalling the similarly angry denunciations which greeted the very idea of the NHS from the same platform in the 1940s.

But it would be rash to assume all of the heartache is synthetic, none of the dissatisfaction justified. The poor state of doctors' morale - and GPs' especially - has multiple causes beyond the inevitable element of shock, anger, panic and denial in the face of major change.

Workload is increasing at a faster rate than the government can sign up new recruits; the public's expectations are rising while its erstwhile confidence in, and respect for, doctors is ostentatiously declining. Pressure on the front line is real - and this matters not just to doctors but to those managing the service, for achieving the NHS plan means changing attitudes and culture; the plan will forever be at the mercy of the professions' goodwill and determination to make it happen. For as long as doctors stare out sullenly from the bunker in which they have allowed themselves to be cornered, little real change of lasting value will take place.

What can be done? First, the bulk of the medical profession should divorce itself from BMA rhetoric, which is heavily laced with political opportunism and expressed always with one eye on manoeuvring to advantage before the next set of contract negotiations. All right and proper for a trade union, but dangerous if doctors allow the public to assume that the posing and exaggerations accurately depict the prospects for a better health service. For example, one delegate condemned the NHS plan as doomed to failure because it owed more to Soviet Russia than modern Britain. If that is the case, what hope is there for the NHS? And does BMA chair Dr Ian Bogle share this despairing view? He, after all, signed the plan a year ago. If so, what would he put in its place? Does the BMA have a blueprint for anything other than preserving its members' privileges?

Doctors need to acknowledge that not all the public's expectations are unrealistic. Though assumptions about what modern medicine can achieve occasionally edge into science fiction, desires for far better access to services and more effective communication are perfectly reasonable. Doctors will have to adapt to provide for them.

For his part, health secretary Alan Milburn must be careful about continuing - in Dr Bogle's words - to 'stoke the fires of anti-doctor publicity'. The scandals of recent years have provided a tempting instrument with which to goad a profession deeply resistant to change and forestall it appealing to the court of public opinion in any campaign against reform. Mr Milburn has used his chances accordingly, where previous health secretaries have shrunk from the challenge. Perhaps the profession has only itself to blame.

But the risk of such a strategy lies in going too far and tipping the profession from readiness to surrender to reform into the belligerent resentment on show in Bournemouth. The risk is highest when the political opportunism is most naked, as it was when Mr Milburn made his Alder Hey speech in the Commons, an episode which particularly aroused Dr Bogle's ire this week. How will Mr Milburn handle publication of the Bristol inquiry report, due before Parliament rises towards the end of this month? Will he calculate that after Bournemouth the situation warrants yet another high-octane onslaught? Or will it be time for the olive branch?

Both sides are playing a dangerous game - with each other, with public confidence and with the future of the NHS. Everyone would be better served by less posturing and more serious concentration on the inescapable problems still awaiting a solution.