British Medical Association chair Dr Ian Bogle's attack on the government at the organisation's conference last week reportedly left health secretary Alan Milburn livid, particularly as Dr Bogle is one of the signatories to the NHS plan.

But according to HSJ sources, his fury was also shared by some of Dr Bogle's colleagues on the Modernisation Board, one of whom even called for the board to explore the possibility of voting Dr Bogle off.

In fact, ditching the doctors' representative from the board is not an option, as the members are appointed by the health secretary and only he has the power to dismiss Dr Bogle, but the antipathy between the government and the BMA has been causing concern across the NHS.

NHS confederation chief executive Stephen Thornton described Dr Bogle's critical conference speech as 'unfortunate' and the government's ongoing row with the medical profession as 'embarrassing'.

'If you look at the warring parties, there is right and wrong on both sides. . . but what We have got to do now is sit down and make things work locally, ' he said.

The BMA view of NHS managers is slightly mellower than its view of the government, judging by the mood of last week's conference, with GP committee chair Dr John Chisholm describing relationships between GPs and managers as 'extremely patchy'.

'There are some very supportive managers who are keen to see primary care develop and want to work with GPs and nurses to implement change. But there are others who are very obstructive to the direction of development that we would like to see, ' he told HSJ.