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The BMA's new chairman, Hamish Meldrum, defends the GP contract and hopes that the new health team will master the art of listening
Hamish Meldrum, the new chairman of the council of the BMA, is a Scot born and bred. That he works as a GP in Bridlington, Yorkshire, is an accident of history that has echoes in today's confusion over junior doctors' appointments.
When Meldrum graduated from Edinburgh in the early 1970s, he expected to start work in the Royal Infirmary there. But a muddle over the appointment found him desperately looking around for a job. Fortunately the consultant involved met a colleague from Torbay, in Devon, who was looking for a trainee.
So Meldrum spent three years as a medical senior house officer and medical registrar at Torbay Hospital, about as far south of the Scottish border as geography allows. He had intended to become a hospital doctor, but his time on the wards was not very enjoyable. “The hospital was not a particularly happy place at the time,” he recalled this week. “There was a lot of disquiet about junior doctors' hours, and I didn't want to go on and join a teaching hospital. So I decided to become a GP.”
It is as the GPs' champion that Meldrum—a youthful looking 59 years old—emerged to win last week's election to replace James Johnson, a surgeon who lost the support of his colleagues by seeming not to care sufficiently about the fate of junior doctors. Meldrum is not about to make that mistake, after successfully navigating the sometimes turbulent waters of the GPs' committee, which he chaired until his elevation.
He was deputy chairman when the new GP contract came into force in 2004, a contract that the ministers who agreed it have been struggling ever since to blame on somebody else. It rewarded GPs handsomely for doing more or less what they had been doing anyway and represented a considerable triumph for the BMA as a trade union. Not many unions ever negotiate pay rises of 26%, combined with the incalculable benefit of GPs no longer having to be responsible for out of hours care.
Not surprisingly, Meldrum is a robust defender of the contract and the quality and outcomes framework (QOF) at its heart. “People say that GPs have been too successful, that the QOF was too easy,” he said in 2005. “Rubbish. Practices have worked extremely hard to achieve such brilliant results. What would they rather have us do? Only give high quality care to 75% of our patients? Or take on only a few domains of the QOF so that we could keep to the budget forecasts?”
Meldrum's skill is to apply the rhetorical flourishes with a gentle hand, more in sorrow than in anger. He is an excellent orator without sinking to abuse, and his speeches always contain a good joke or two.
He told the conference of local medical committees in June, “It costs the NHS less for a patient to be registered with a GP practice for a year than it does to insure a year's veterinary fees for a hamster.” Of the government's flagship reform, practice based commissioning, he compared the lukewarm reception to “buying a ticket to a celebrity party and finding that only Jade Goody has turned up.”
Meldrum's introduction to NHS politics was inspired by Kenneth Clarke, the then health secretary, imposing a contract on doctors in 1990. “I felt that the leaders of the BMA should have resisted more strongly,” he said. “That's what really spurred me on to stand.”
By this time he was well established as a GP in the seaside town of Bridlington, in a practice that looks after mostly elderly patients, together with a fair number of summer visitors. He was elected to the GPs' committee in 1991.
He became chairman of the BMA the same day that the new health secretary, Alan Johnson, took office. The two have already had a brief conversation, and Meldrum is in no doubt about what he wants to see from Gordon Brown's government. “I hope to see fewer of the tensions between number 10 Downing Street and number 11 and the Department of Health” he said. “Under [Tony] Blair, number 10 was very keen on high profile, consumerist, market policies, while number 11 was more interested in financial stringency, and the department was piggy in the middle.”
He called at the BMA's recent annual representative meeting in Torquay for “new, meaningful partnerships” with the government, “consulting us, involving us, not just hearing what we say but really listening to us.”
A few key matters will be the test of this new relationship, if it emerges: a new contract for staff grade doctors, an equitable answer to the crisis over junior doctors' training, and a solution to the row over GPs' pensions, which is going to the courts. Longer term are the matters of revalidation of doctors and changes to the General Medical Council, where he fears that the government is on a collision course.
“We have a system where a huge bureaucracy set up to weed out 20% of underperforming doctors browns off [annoys] the 80% who aren't underperforming while not finding the 20% who are,” he said.
After 10 years, most doctors seem to have fallen out of love with the Labour party. But no prime minister will want to fight an election in which the NHS will loom large with the profession against him. So Meldrum may have the leverage to make some progress. If he fails, it won't be for lack of persuasive advocacy or charm.