Giving doctors a voice

DR Hamish Meldrum was elected chairman of the BMA council in 2007 but has long been active in medical politics. He first joined the General Practitioners Committee (GPC) in 1991 and was part of the team that negotiated the current GMS contract, serving as GPC chairman from 2004 to 2007.

In November he was ranked third in the Health Service Journal 100 most influential people in health, moving up from 32 on the 2009 list with the BMA now having a crucial voice in debate over proposed NHS reform in England. Professor Steve Field, former chair of the RCGP, writes in the HSJ100:

“The fact Hamish has held the position of council chair for three years is no small feat and says much for his abilities. I have seen him in action, he is incredibly skilled and the BMA is stronger because of him.”

Dr Meldrum graduated from Edinburgh in 1972 and in 1978 became a GP in Bridlington, East Yorkshire where he still practises one day a week. He is married with three children and two grandchildren. He has been a member of MDDUS since he qualified.

Back in July of 2010 you described the Government White Paper on NHS reform as a curate’s egg – “good in parts, bad in parts, unclear in parts and even internally inconsistent in parts.” Have your views changed over the past few months?

Not really, the BMA has sent in a detailed response, outlining the areas we support, those with which we have concerns and those where we need far more information. The government is due to respond just before Christmas with a bill coming out early in the New Year. We will see whether the curate’s egg has improved or turned more rotten!

In its response to the White Paper the BMA has spoken out against a “market-based approach” to healthcare? Do you think any form of competition is useful in a national health service?

I think healthy competition between clinicians, based on good-quality data on their performance, is fine. What we object to in many of the recent policy developments in England is the fragmentation, increased bureaucracy and increased administration costs of the market-based approach. It also runs counter to the principle of social solidarity on which the NHS is based.

You said recently that some of what has been proposed by the Government is what doctors have been demanding for years. Can you expand on this?

There is no doubt that clinicians feel that they have become relatively detached from the decisions that affect the way they practise. In principle, giving doctors more say in the design and running of services, greater patient involvement and a focus on high-quality outcomes rather than crude targets can only be a good thing.

The recently published NHS Atlas of Variation exposed a postcode lottery in some key treatment areas such cancer and diabetes. Will GP consortia with ‘localised’ decision-making improve or worsen this situation?

I would hope that with improved data on outcomes this will help to narrow the quality gap but the recent announcement potentially to lessen the input from NICE in determining which treatments will be available could undermine that. Do you think the White Paper plans would inevitably open the door to some form of privatisation? There is no doubt that some of the proposals – all hospitals moving to FT status, the idea of “any willing provider” and the economic regulator being asked to encourage competition – are all very worrying signs that there could be increasing private provision of NHS services. Another concern is that, in a time when funding is constrained, patients may be encouraged or even forced to “top up” their treatments from private sources and the NHS will cease to be comprehensive.

What if any benefits do you see in eliminating practice boundaries in primary care?

Very few and those that there may be – such as increased choice for patients – may be greatly outweighed by additional bureaucracy, loss of continuity, fragmentation of care and funding allocation problems.

Do you see any dangers in the diverging approaches to healthcare provision among the devolved UK national governments?

Well, we no longer have a UK NHS; we have four national NHSs with many distinct differences. There are worries about moving away from UK terms and conditions for doctors and devolution of training, education, workforce and regulation which would create unnecessary cross-border tensions.

Do you think a £20 billion cut in spending in the NHS is achievable and where do you think savings could be achieved?

The suggestion is that the service needs to identify £15-20 billion to reinvest to meet rising demand. As yet, we do not have a narrative, either national or local, which might suggest how this could be done and the NHS has never achieved such savings in the past. Getting rid of the bureaucracy of the market would be a good start, as would trying to reduce the expensive impact of the PFI. The NHS workforce has already agreed to accept a two-year pay freeze so NHS employees are already doing their bit.

Is the public sector bearing an unfair burden in the economic crisis?

In the sense that it didn’t create the problems, yes, and there is no doubt that there have to be some reductions in public spending together with some increase in taxation, but I think the public sector still feels it is being made to pay, unfairly, for other people’s mistakes.

Is the EWTD (European Working Time Directive) dead in the water now that the Government seems to have stopped monitoring compliance?

No, the EWTD remains part of EU law. Although its introduction may have exacerbated some problems in junior doctor cover and training, it didn’t cause them and simply ignoring the legislation or attempting too repeal it, will not work and would be retrograde. Addressing the problems of junior doctor training is a complex business and the EWTD should not be used as a scapegoat for long-term failings in this area.

Do you think the GMC is getting close to a workable revalidation system?

It’s often seemed a case of one step forward and two steps back over the 12 years that revalidation has been on the cards. It is absolutely vital that any system is not overambitious, has the confidence of the vast majority of doctors and is properly resourced both in terms of the revalidation process itself and any remedial issues that arise from it.

Professor Steve Field has described your role as chair of the BMA council as the most unenviable job in medical politics and likened it to herding cats. What inspired you to take on the role?

Whether it was inspiration or more a case of being in the wrong place at the wrong time, I don’t know! Seriously, wanting to try to make a difference rather than just complain from the sidelines is what got me into medical politics in the first place. I certainly had no burning ambition to be chairman of the BMA, or any expectation that I would end up there but I enjoy a challenge and want to try to do what is best for doctors and the wider NHS in which most of them work. Luckily, most of the time, these two ambitions share much common ground.

No doubt you are very busy – can you describe a typical week?

I still try to spend one day a week in my East Yorkshire practice – usually a Monday which I try to keep free of BMA activity, not always successfully! I travel down to London on Monday evening and my week consists of office work, meetings – both internal and external, conferences, speaking engagements, media and parliamentary works as well as chairing Council and several other major committees in the BMA. Many people forget that the BMA has a much-respected professional side covering ethics, science and international issues as well as a very successful publishing group. As chairman of the BMA I have a role in overseeing all of these. I suppose I deal with 100-150 emails a day and that, together with associated reading and evening meetings and (sometimes working!) dinners, doesn’t leave a lot of time to spare. I try to spend most weekends at home, though there is still a lot of paperwork to catch up on plus quite regular phone calls, but if there is a window of opportunity, I try to squeeze in a game of tennis – in a vain attempt to get rid of the side effects of the working dinners!

Interview by Jim Killgore, editor of MDDUS Summons