Now the whole medical profession is alienated. And it's all Tony Blair's fault. Joanna Lyall reports from the BMA's annual conference

Any expectations the government had of a gentle summer in the NHS must have been jolted by the breadth of attacks against it at the British Medical Association's annual representative meeting in Belfast.

First it passed resolutions protesting, among other things, about bureaucracy, lack of transparency in rationing, the private finance initiative, junior doctors' conditions, and the withholding of an extra£50m for consultants' pay awarded by the pay review body.

Then it greeted a personal attack on prime minister Tony Blair by BMA council chair Dr Ian Bogle with a standing ovation.

He accused the government of pandering to popular opinion and failing to consult the profession when introducing new policy initiatives.

'I read about walk-in clinics when I picked up my newspaper and read an article quoting an unnamed government source.

'Floating policy initiatives by feeding stories to friendly journalists appears to have become this government's preferred method of communication, ' said Dr Bogle.

'An administration that has turned media manipulation into an art form clearly favours spin-doctoring over consultation with those of us who will have to put its grand plans into action.'

Dr Bogle said that after a decade of disruption the profession was faced with yet more organisational upheaval in the form of primary care groups, NHS Direct and walk-in clinics.

'I'm neither opposing nor supporting them because I simply don't know if they will improve healthcare. And never let it be said that they failed because we didn't try to make them work. But the pace of change is frightening.'

He called on Mr Blair to slow down the pace of change in the NHS and pilot innovations where possible.

'Walk-in clinics may pander to public demand for 24-hour access to the NHS. But will they relieve pressure on an understaffed and under resourced service?'

Listing the problems facing GPs, junior doctors and consultants, Dr Bogle said: 'Congratulations, Mr Blair. You have managed to alienate the whole profession.' He said morale was now as low as it had been in 1992 when it became clear the internal market was there to stay.

The BMA's 'Stop the Exodus' campaign, aimed at keeping doctors in the NHS, had produced a 'staggering' number of letters from doctors who felt demoralised and undervalued.

Dr Bogle said he believed there was a drive at government level to undermine public confidence in doctors' work.

'Poor performance, where it exists, is indefensible and must be remedied swiftly. However, the adverse publicity the profession is receiving - some of it whipped up by government spin doctors - is confusing patients into believing poor practice is more common than it actually is, ' he said.

Dr Bogle's speech prompted an immediate rebuttal from the Department of Health, which said the BMA had voted three to one in favour of the reforms, including primary care groups.

The statement said the DoH had received 100 bids to pilot the first 20 walk-in centres, adding: 'What we are seeing at the moment is the inevitable product of the difficulties of introducing change in any large organisation.'

Mr Blair himself later waded into the row with a strong defence of the private finance initiative in which he criticised the doctors' leadership.

At a press conference, Dr Bogle said he believed doctors' leaders were being excluded from policy consultation because the government did not believe they could work with politicians and managers to introduce change.

Dr John Chisholm, chair of the BMA's GPs' committee, said: 'There is considerable support for the strategic direction, but it's how the reforms are being implemented which is causing such concern.'

See politics, page 19.

Sounding board Dr Bogle's views were echoed by some of the 550 doctors at the conference.

Dr Kailash Chand, GP in Ashton-under-Lyme and member of West Pennine local medical committee 'If anything, the speech understated the feeling at grassroots level. I voted Labour but I feel totally let down. I thought they would abolish the internal market and let doctors get on with treating patients. But they are steamrollering through reforms. The BMA's opposition is overdue. The grassroots expected more robust opposition to the undermining of GPs' traditional role early on.'

Dr Mary Church, GP in Blantyre, near Glasgow 'The speech was an accurate reflection of the mood of the profession. General practice was enjoyable until 1990. Now we have gimmicks like NHS Direct and walk-in centres but they are not looking at the quality of the service.'

Dr Tom Hawkins, retired anaesthetist, Belfast 'I retired 18 months ago at the age of 60 because I was fed up with doctor bashing.

There was a culture change and I was not prepared for managers telling me what to do.'

Dr Anne Shephard, GP in Worcester Park, Surrey 'This government does seem to do things feet first with no consultation. If we had the£20m going into NHS Direct we could set up our own practice services with triage nurses. Constant imposed change is demoralising. I like developing services for patients in my own way.'