What a week for letters it's turning out to be. Below is the text of BMA chair of council Dr Hamish Meldrum's letter to his guild.

"Dear Colleague,

"The publication of the health White Paper will, no doubt, have left you with many questions about the impact this is likely to have on you and your patients.

"I am writing to you to let you know how the BMA is responding and will continue to respond to the consultation process that is currently taking place on the NHS in England, how we intend to keep members informed of progress, how the BMA can and will support members and, just as importantly, how you can give us your views on the consultation.

"Just over two weeks ago, the Secretary of State for Health in England, launched the health White Paper, Equity and Excellence: Liberating the NHS, and, following this, there have been further consultation papers on specific aspects of what is proposed. If you haven’t read these documents – or, at the very least, the summaries on the BMA website – I urge you to do so by visiting www.bma.org.uk/healthcare_policy/index.jsp

"Taken together, these proposals represent very significant changes to the organisation of health services in England. The proposals include increased responsibilities for doctors, the phasing out of PCTs and SHAs and a greater focus on outcomes, as well as perceived threats to education and national terms and conditions of service.

"There are also very significant proposals for the future of public health, with closer working with local authorities and ring-fenced budgets intended to ensure the provision of a wider public health agenda.

"Clearly, the changes proposed are significant and wide ranging. Many consider the White Paper to be something of a large curate’s egg; good in parts, bad in parts, unclear in parts and even internally inconsistent in parts. Many are concerned that it will increase the role of the market in healthcare and result in the increased participation of the commercial sector.

"Despite, and more importantly, because of these concerns, the BMA believes that it is absolutely vital that we critically engage with the consultation process. Government has clearly indicated its overall direction of travel and non-engagement in the consultation period would greatly increase the risk of bringing about the adverse outcomes that many of you fear. The proposals will have a huge impact on you and your patients and it is through critical engagement that the BMA will be best able to ensure that the views of the profession are represented in the consultation process.

"One of the key planks of the government’s proposals is to devolve more involvement and financial control in commissioning to GPs. The BMA has made it abundantly clear that, for commissioning to be successful, there must be the fullest engagement with secondary care colleagues and, indeed, with the public. There is an opportunity here for doctors to take more control over their working lives and the design of services for their patients, but only by working together, in partnership, will doctors be able to maintain or even improve these services in these financially constrained times.

"Commissioning will also require high-quality management support and we fully expect that consortia will wish to engage with experienced NHS managers to work with them, both in developing their plans but also in the longer term.

"We will also be working to ensure that, in developing the outcomes’ framework, any outcome measures are fair to doctors and understandable by patients.

"By engaging with the consultation process, the BMA is not deserting our “Look After our NHS” campaign. Quite the reverse. We believe that it is only by responding critically to the challenges and the potential consequences of the government’s proposals that we can defend the founding principles of the NHS and the principles underpinning our campaign.

"Although the proposals in the White paper apply to doctors working in the NHS in England, we are aware of concerns of colleagues in the three other nations that these proposals could have an adverse, knock-on effect in their countries. These concerns lie particularly in the areas of education and training, the preservation of national terms and conditions of service and whether unwelcome aspects of the market might leak across the English border.

"I wish to assure you that the BMA will listen to these concerns and will be doing all it can to support members during this time. As well developing plans for practical guidance, advice and direct support, we will also seek to strengthen our local structures to help protect members on both a local and national scale. We will be giving you further information about these in due course.

"We particularly welcome your views on all aspects of the White Paper. You can keep up-to-date on developments through BMA News, the special health White Paper pages on our website and via our weekly electronic newsletter. We will also be seeking more structured assessments of members’ opinions through various avenues. In the meantime, please tell us what you think by emailing us: info.whitepaper@bma.org.uk

"I am in no doubt that this is a very challenging agenda and that it is not without risk. There are challenges for the NHS, for the profession and for the BMA but I believe that it is vital that we rise to the challenge and, together, try to ensure that we mould these proposals into a set of solutions that can benefit our patients and the working lives of doctors.

"Yours sincerely

Dr Hamish Meldrum
Chairman of Council, BMA"