The British Medical Association council chair has said the government’s changes to its NHS plans are “more than a respray job”.

Hamish Meldrum was speaking after the BMA annual representative meeting in Cardiff voted to call for the withdrawal of the Health Bill, despite the proposed amendments, contrary to Dr Meldrum’s advice. However, the meeting voted down a motion calling for the BMA to oppose the bill “in its entirety”.

Dr Meldrum said he could “see the argument” that the withdrawal vote would give him additional strength to argue for further changes to the bill.

However, he said: “There will be elements of the government that will say it doesn’t matter what you say to the BMA, it doesn’t really make them any happier…

“I only hope [the vote] hasn’t got people [politicians] into a position where they won’t give us any more.”

Dr Meldrum rejected suggestions the changes were not substantive and said: “I think it is more than a respray job.”

In particular he said there had been change to the proposed application of competition, and said he did not share concern about the government’s continued promotion of choice.

He said: “I don’t accept that choice is the same as competition, so I think we have made significant progress.”

Dr Meldrum said concern remained about the secretary of state’s responsibility for NHS provision. He said: “We need to see clarity about what the amendments actually mean. There seems to be some debate even between constitutional lawyers.”

He said there was concern about the power of the NHS Commissioning Board over clinical commissioning groups, and  about the apparent roles of clinical senates and health and wellbeing boards in influencing CCGs.

He called for the government to be more clear about, “how [CCGs’] decisions relate to health and wellbeing boards and the NHS Commissioning Board”.

He said: “There are still issues around governance arrangements for the health secretary to the board and the board to clinical commissioning groups.

“We can try to clarify these issues [in coming months].

“If you are going to go forward with clinical senates they should be part of CCGs. We can’t have another layer sitting over CCGs. They should be there to help and advise CCGs.

“We need much more clarity about the national board and its outreach processes [local arms]. There is still a lot of detail that needs to be worked out – that won’t be in primary legislation.”