This year, the British Medical Association's annual representative meeting follows 14 months of Labour government. But the doctors' leaders don't seem very happy. Lyn Whitfield reports

The British Medical Association's 'annual parliament' was in a subdued mood in Cardiff last week.

The excitement of Labour's election victory, which added fizz to last year's annual representative meeting in Edinburgh, had largely evaporated.

Outgoing BMA council chair Sir Alexander Macara set the tone with his final speech to the annual meeting.

'Much of what the new Labour government has said and done has been in tune with the concerns of doctors in this country and they have proved to be good listeners, ' he said. 'But the jury is still out. They must not assume that the measured welcome we have given to their policy statements denotes unthinking collaboration with anything they may subsequently propose.'

Sir Alexander said the government needed to 'face the facts' that more hospitals and consultants were needed.

He said government 'as a whole' needed to take action on health inequality because 'for too many of our fellow citizens it is still cruel Britannia not cool Britannia that we live in'.

He strongly criticised the 'about-turn that would be a comic turn if it were not tragic' that the government had executed on the private finance initiative and urged it to face up to rationing by ordering its priorities 'equitably and effectively'.

Sir Alexander also referred obliquely to the government's quality agenda, saying: 'The essence of professionalism is the freedom and responsibility to exercise personal, professional judgement within a framework of self-regulated competence.'

The meeting later passed a motion 'insisting' that clinical governance should be 'bottom-up' and part of professional self-regulation - but resourced by the Department of Health.

'If doctors do not do this, clinical governance will lead to a culture of inspection and defensive medicine, ' Forth Valley GP Brian Keighley warned.

Doctors' representatives also warned against 'crude' league tables.

'We need to get away from the spurious accuracy of league tables which pretend it is better for a hospital to be 21st than 35th, even when there is no statistical difference between them, ' argued consultants' leader James Johnson.

'What we want is an envelope of average results that tell most people they are doing all right. Then we can deal with the outlyers.'

The meeting echoed Sir Alexander's views on rationing by calling for 'national frameworks for priorities'.

But speakers were unimpressed by one of the government's first prioritisation exercises: the white paper promise that people with suspected cancer would be seen by a consultant within two weeks of diagnosis by a GP.

'The imposition of waiting times for specific treatments should be opposed, ' said East Dorset GP Fiona Randall.

'Doctors already prioritise patients on the basis of need and political interference will not make that easier. Other people not in these groups will have to wait longer. And it does not follow that this will help patients. The fact that they are assessed within two weeks says nothing about their subsequent treatment.'

Doctors also lashed out PFI. Last year, the ARM, which sets BMA policy, voted to support the 'limited exploration of PFI as a means of fundholding within the NHS'.

This year, it hardened its stance, calling for PFI to be 'abandoned' - against the advice of Sir Alexander, who argued that for all its faults 'it is the only way we have at the moment of getting the resources we need'.

But the fiercest attack on government policy came from GPs opposed to primary care groups.

A bad-tempered debate on a motion calling for 'a ballot of all GP principals to determine whether a majority support the creation of PCGs' was overshadowed by a discussion on introducing expensive new drugs to the NHS, which came to life for the press when the magic word 'Viagra' was mentioned.

But a number of GPs expressed fury about the PCG plans - claiming it would turn them into 'rationers of care'.

Hardliners also criticised concessions on the control and funding of PCGs extracted from health minister Alan Milburn by the BMA's GP negotiators, led by John Chisholm.

Western-super-Mare GP Philip Carman claimed they had 'rolled over like puppies and asked to have their tummies rubbed by Mr Milburn'.

The meeting threw out the ballot motion by a two-thirds majority and later congratulated the negotiators on their 'success'.

But it also voted that 'the pace of change necessary to set up PCGs is unmanageable and may destabilise the NHS'.

At a press conference, senior BMA figures denied the critical motions showed doctors had 'fallen out of love' with the Labour government.

'Our job is not to fall in or out of love with this government or any government, ' said Dr Chisholm. 'We would be failing in our job if we did not criticise government when we see things that are wrong.'

Sir Alexander agreed. 'They do not have to go so far out of their way to invite criticism. . . but we have been pointing these things out to them, ' he said.