A fair few buckets of the midnight oil must have been burnt for the BMA to produce the 48-page agenda for its Special Representative Meeting next Tuesday.

The BMA's leadership find themselves between a rock and a hard place. They face the SRM ending in a near-certain mandate to move to outright opposition to the Bill.

If this is the result, the current leadership's positions would look untenable, and they would likely feel obliged to resign.

The current leadership have made one very smart move to wrong-foot their opponents: they have decided that the live webcast of the meeting will be unrestricted access. Anyone can tune in.

Hamish Meldrum and Laurance Buckman had their 'smart politics' heads on, in making that call. They are betting that the rockers - those who believe they can dash the Bill to pieces on the rocks of resistance - may tread more warily, knowing that many more eyes and ears are watching the meeting.

Meldrum and Buckman know that outright opposition to the Bill is a suicidally high-risk strategy.

They also remember that the last time the BMA went for outright opposition to the Kenneth Clarke reforms, the Government pushed them through anyway.

The future of The Liberator
Andrew Lansley is no Kenneth Clarke. That Nice Mr Cameron has backed his Health Secretary for now - although with the proviso of lumbering Lansley with Comrade Sir David Nicholson as his NHS Commissioning Board Money-Manager-In-Chief (top-slicing a speciality).

If the BMA move to outright opposition, that would be another Bad News Day for Mr Lansley. He has had quite a few of those.

But there would be a payback. Number 10 would then spin the BMA as the forces of conservatism. The issue of doctors' pay and hours would magically crop up in much of the media.

Lansley is safe for now - until the waiting times go north and the money goes south.

Now, if rumours that demand is being pent-up until the new financial year with commissioners leaning on GPs to reduce or delay referrals prove correct, that safety could be very short-lived indeed.

Then we get The Bosanquet Scenario.

The top 30
The timetable clearly stands no chance of any form of discussion of the 205 motions, many of which are filled with litters of sub-clauses. Motion 92 sticks out, with 28 sub-clauses, running from a to bb.

That is not, anyway, how BMA SRMs work. The only motions that stand a chance of discussion are the first 30 or so.

Watch out at the start of the meeting for the more hammer-and-sickle tendency committee members to push for various of their favoured agenda items to be pushed up the agenda. Arguments over this are likely to take the first hour of the meeting.

Bring Me The Head Of Andrew Lansley!
Motion 177, copied below, is the 'Bring Me The Head Of Andrew Lansley' one:
* 177 Motion by LONDON REGIONAL COUNCIL: That this Meeting has no confidence in the Secretary of State for Health, Mr Andrew Lansley.
177a Motion by BUCKINGHAMSHIRE DIVISION: That this Meeting has no confidence in the Secretary of State for Health (England) who:-
i) has reneged on his pre-election promise not to reorganise the NHS management structures;
ii) has demonstrated that he is unfit to lead the NHS by failure to assess whether GPs have the willingness, capacity or competence to mange £80 billion of the NHS budget;
iii) has demonstrated his desire to destroy the public's trust in their GPs;
iv) claims his reforms are evidence based when there is no evidence that they will achieve any benefits to the public purse or patient care;
v) should withdraw his ill thought out health Bill forthwith.
177b Motion by LEWISHAM DIVISION: That this Meeting has no confidence in the Secretary of State for Health, Mr Andrew Lansley, and calls for his resignation.
177c Motion by BIRMINGHAM DIVISION: That this Meeting would not buy a used car off someone who had trumpeted no ‘top down’ re-organisation of the NHS prior to being elected and then proceeds to introduce a massive and clearly long planned re-organisation of the NHS after being elected.

Well, I suppose it adds to the gaiety of the nation.

Note the above comments about these Motions being practically at the back of the agenda: any lower-down the running order, and they'd be in an appendix. The agenda committee have proved well worth their salt.

Mods and rockers
The modernisers get their chances, with such groups of motions as:
176 Motion by EAST KENT DIVISION: That this Meeting congratulates the BMA Council on its active engagement with the Government over the Health and Social Services Bill and mandates Council to robustly pursue amendments to the Bill that will reduce the inherent risks to patient care and promote the safety and quality of medical and social care.
176a Motion by SCUNTHORPE DIVISION: That this Meeting believes a correct BMA response to government policy should include selective support, constructive criticism, and targeted opposition, and therefore endorses the current BMA policy of critical engagement with the government over proposed NHS reform in England.
176b Motion by EASTERN REGIONAL COUNCIL: That this Meeting supports the BMA Council policy of critical engagement as the best method of realising the necessary improvements in the Health and Social Care Bill and more importantly assuring the quality and safety of patient care through strong clinical leadership.
176c Motion by NORTH & MID STAFFORDSHIRE DIVISION: That this Meeting supports the view that although the reforms include a number of good ideas and development, as a package they are nonsensical because they fly against the research evidence set out by many commentators such as Kieran Walsh in the BMJ, Anna Dixon and colleagues at the Nuffield and the Kings Fund. The likely consequence of the reforms are fragmentation of care, widening of the gulf between primary, secondary and community services leading to reduced quality at increased costs. The BMA should make more aggressive efforts at modifying the
reforms and put forward an alternative to the current reforms.

Those who want to dash the liberation theology of Mr Lansley on the rocks of resistance get plenty of say too: you can read the lot at Section 175, but the Agenda Committee summary is:
175 Motion by THE AGENDA COMMITTEE: That this Meeting:
i) believes the BMA stance of “critical engagement” with the government failed, and
ii) calls on the BMA to oppose the Bill in its entirety;
iii) calls on the BMA to publicise and oppose the damaging elements of the Bill;
iv) calls for the BMA to consider what form of action should be taken by the medical profession.