All shook up

It is an image to conjure with. Wagner's Ride of the Valkyries blasting out of the CD and a picture of former Conservative health minister Gerry Malone to focus your rage.

Laughing at the memory, Ian Bogle, the new chair of council at the British Medical Association, confesses that this was how he fired himself up for one particularly tough speech during the doctors' battles with the previous government.

Dr Bogle now has what he calls 'the most high-profile job in British medicine'. He says he has no more career ambitions to fulfil - although he has a degree of trepidation about filling the shoes of Sir Alexander Macara.

Liverpool born, a third-generation GP, Dr Bogle, who is 60 in December, has been in medical politics for 30 years. He was involved in some high- profile and largely successful battles with the Tory government as chair of the BMA's GP committee .

He has also recently gone public about his daughter's anorexia and the strain it placed on his marriage, in a bid to get more publicity and help for the condition.'I got a lot of sympathetic press, but the sympathy was for me and not the sufferer, which was wrong.'

He says he has no intention of delving into his personal life again in public, but that he is happy to offer help or support in a private capacity.

There can be few at the top table at the BMA's Tavistock Square headquarters who have a love affair with country music so deep that they have, more than a dozen times, visited Graceland, the former home - and now shrine to - Elvis Presley, in Tennessee.

Dr Bogle even DJs a country music disco at his local golf club. 'It's for private functions only and will not become a feature of the BMA's Christmas party,' he says.

He thinks that Wotan and Brunehilde, not Elvis or Hank Williams, may again come to his aide in future battles over pay and the structure of the review body.

But it may be that a picture of chancellor Gordon Brown, rather than that of health secretary Frank Dobson, is used to focus his oratorical fire.

'I met Frank Dobson a couple of times when he was shadow health minister. He is exceedingly easy to talk to and listens to the arguments. I also think he genuinely likes his job.

'But he is just one part of a big powerful government with a big majority, so I don't believe he has a surplus of freedom.'

He cites the surprise visit of Mr Brown to the review body last year and the decision to stage the last doctors' and nurses' pay rise as a sign of where the real power lies.

'The staging went against the whole spirit of why the review body was set up.'

But he says the problem for negotiators is that the government is a monopoly employer, and the employees considered that strike action was 'not on the agenda'.

Dr Bogle resigned from the board of Liverpool health authority in 1979 over rationing. He later rejoined it.

Now he is concerned that fledging primary care groups could bear the brunt of rationing demand for 'lifestyle' pharmaceuticals such as Viagra, or get caught in Child B-style flak.

'The level that PCGs are pitched means that risk management will be better than in a fundholding practice, for instance. I think there really does need to be some mechanism for handling potential problems like this.

'I think you need a schizophrenic approach to rationing - ration at PCG level, but never let that rationing debate into the consulting room.'

Although he is happy that GPs will dominate PCG boards, 'as it is largely about spending general medical services money', he agrees that other groups need to help handle what he calls 'megabuck budgets'.

'It's important that health authority senior managers work in co-operation with the medical profession locally, and involve managers in decision- making.

'There are a lot of relationships that have not been spelt out yet and I don't think that any of the most advanced PCGs will know what they are going to be doing by April next year. It will take a year to sort out relationships.'

How the new National Institute for Clinical Excellence and Commission for Health Improvement will impinge on doctors' ancient right of self- regulation, in the wake of the Bristol children's deaths, could become another battleground.

One of Dr Bogle's first official functions was to attend a meeting with members of royal colleges and consultants' groups last month called by Sir Donald Irvine, president of the General Medical Council, on standards, discipline and accountability, and merit awards.

He says the profession was moving towards a system of consultant peer appraisal and assessment, comparing results against local and national norms, and a re-accreditation system for GPs, before Bristol hit the headlines.

'We want to give the public the message that we are a quality profession providing a quality service.

'This has been evolving. You only have to look at what has been published on standards by the British Thoracic Society, the Royal College of Anaesthetists and others like the BMA's GP committee on re-accreditation.'

There is, however, no specialist register for GPs comparable to that of the consultants. A GP register has to be created so they can be assessed for 'merit' in the same way as hospital colleagues.

The final stumbling block is making sure that the system works uniformly across Europe, to allow unrestricted access to labour markets.

'Europe is moving in the same direction as the UK on this issue. Training programmes differ in each country, but there is still freedom to practice across the European Union.

'We want to make it clear that this system is not designed to catch out the underperforming doctor. It is designed to say that this doctor has a specialist registration that means his or her standards have reached a certain level that is acceptable to patients.'

Dr Bogle and many other clinicians hope that a very public demonstration of a profession getting its house in order and taking regulation and discipline seriously will enable them to head off outside intervention.

'I would like intervention from NICE or CHI to be a very rare event,' he says.

He wants both organisations to include medical representatives, but thinks that for public credibility the commissioner of health improvement should be a lay person.

Like Mr Dobson, Dr Bogle wants to 'check the legalese' involved in clawing back Bristol surgeon James Wisheart's merit award, but he argues that the system of rewarding excellence should continue but in a more open way to include more lay persons.

Elected in June, Dr Bogle says he has not been in the job long enough to make changes or to create waves - despite allegations to the contrary by senior management figures. 'I usually take a pragmatic approach to negotiations. I am not a confrontational type,' says Dr Bogle.

He managed to chalk up successes, particularly on GP out-of- hours care, as chair of the BMA's GP committee during negotiations with the previous Conservative health secretary, Stephen Dorrell.

But he cites everyone's favourite bogeyman, Brian Mawhinney, as the first minister to recognise the need for a significant change, particularly removing the commitment to providing 24-hour care from individual GP contracts.

Of the Dorrell era, he says: 'It was a combination of a much lower government majority and an ability on his part to listen, take on board what you were saying and adjust his point of view.'

So, how does he vote?

'Politically, I am right in the middle. I think I can say after 30 years in medical politics nobody knows my own political allegiance... or my religion either.'

Life and times: Ian Bogle

Born: Liverpool, 11 December 1938.

Family: married, two children.

Educated: Liverpool College; Liverpool University. Qualified MB ChB, 1961.

Local BMA posts: member, Liverpool LMC since 1969; secretary, Liverpool LMC, 1972-90.

National BMA posts: member, general medical services committee, 1979 to date; chair, GMSC, 1990-97; member BMA council since 1988; member BMA executive since 1990; director BMA professional services since 1997.

Public offices: Liverpool family practitioner committee,

1974-90; Liverpool health authority, 1977-89. Former chair, Anfield Citizens Advice Bureau.

Hobbies: music, photography, golf, travel.