The new chairman of the British Medical Association has distanced himself from one of the union's major recommendations for health service reform.
Dr Hamish Meldrum has outlined his reservations over proposals for a new type of trust that would bring together commissioners and providers, ending the purchaser-provider split.
In an interview with HSJ, he said that although he wanted to see managers and clinicians collaborate, 'you are never going to get rid of competition'.
In May, the BMA called for the establishment of health economy foundation trusts (HEFT) where the separation of purchasers and providers were creating 'stubborn divisions' (see 'BMA sets out plan to close purchaser-provider divide').
It was among 24 recommendations set out in its A Rational Way Forward for the NHS in England discussion paper, published before Dr Meldrum became chairman and touted by supporters as an 'alternative approach for the reform of the NHS'.
But Dr Meldrum said last week: 'I have some reservations about the HEFT model because there is a difference between involving primary and secondary care in discussions but actually lumping them into one trust could create problems.'
Good clinical governance would achieve greater improvements than keeping or removing the purchaser-provider split, he said.
'The move away from the market should be evolutionary. For some people everybody going into one organisation may be too cosy and comfortable. People may want to keep their separate identities,' he said.
'You're never going to get rid of competition, for example between GPs. A lot of competition comes from just wanting to do a better job, to see what your colleagues are doing and trying to do better.'
His views contrast with the BMA's discussion paper, which is out for consultation until 7 September. It says where HEFTs were adopted these would supersede foundation trusts: 'The HEFT model could revolutionise relationships between local health systems and communities.'
The HEFT boards would include representatives from hospitals, general practice, community providers and public health.
NHS Confederation policy director Nigel Edwards said Dr Meldrum's concerns were well founded as the provider-purchaser split would always exist, even if it was not explicitly stated.
'Many of the problems we face in the health service are not about structures but relationships,' he said. 'If the relationships aren't good then lumping everybody into one organisation won't make it any better. It would just be internalising the problem.'