Good morning representative body chair, secretary of state and colleagues.

The whole nation knows that the health service is in deep crisis. The family doctor is harder than ever to see. Waits for hospital appointments are too often measured in years, not days and weeks. Each year tens of thousands of people wait more than 24 hours to be admitted to hospital from the emergency department.

Public health has been broken by restructure and neglect, with no attempt to revive it despite the pandemic exposing how fragile our nation’s health has become. Despite understaffing across the NHS, we are facing the absurd spectacle of doctors out of work. 

Hospital doctors, GPs, medical academics and public health doctors are all facing unemployment or training bottlenecks, jeopardising the futures of talented and dedicated doctors. The social contract between the medical profession and society has been broken. Each of these issues is contributing to the sense today that the NHS is far removed from what it once was,  and far removed from what it should be.

Our patients rightly expect far better, because they remember the NHS when it worked. A family doctor who knew them. An emergency department that was properly resourced without the prospect of being treated in a corridor. They remember an NHS that could treat them safely and with dignity. RB, no one should underestimate this crisis. As doctors we see it unfolding every day of our working lives.

Patients unable to access treatment. Doctors unable to provide the care they were trained to deliver. A spiralling crisis and a disjointed health service which demands a solution. So a long-term plan for the NHS is not just appealing but is essential. 

I want to start by thanking all of you for attending this special representative meeting, the first in over a decade, to discuss exactly these issues. As doctors, and as the British Medical Association, it is our responsibility today to consider and to scrutinise the proposals contained within the 10 Year Plan for the NHS.  

As the representative body, you are democratically elected to represent 200,000 doctors and medical students. You are the voice of the medical profession. Today’s meeting represents the urgency of this moment. It is our chance to debate our concerns, to guide the BMA in its work with Government and to speak truth to those in power. 

And while the plan is specifically seeking to address the challenges in England, we know that many of these problems are common across the UK, and its solutions are likely to be adopted in the devolved nations. 

So if you are representing members in Northern Ireland, Scotland or Wales, your views are important, valued and must be heard. 

Ahead of this meeting we surveyed thousands of our members and held workshops to understand their views to inform our debate. We have also published a detailed analysis of the plan which considers the three main ambitions it hopes to achieve: to shift care from hospitals to the community, to harness new technologies and to focus on preventing ill health.  

Beyond these three main ambitions lie other major reforms. A new workforce plan; reforming NHS finances; a new operating model; greater transparency for hospital performance – with league tables published just last week; and a new innovation strategy.

Ambition isn’t lacking with these goals, but an ambitious plan must be accompanied by ambitious delivery which carries the confidence of the medical profession. 

Within the plan the Government has committed to prioritising UK graduates and established International Medical Graduates to help alleviate specialty training bottlenecks.  

The pledged increase of just 1,000 further places is a welcome start but won’t be anywhere near enough to tackle what has been a crisis years in the making. Eye-watering student debt and the harrowing day-to-day working experiences of resident doctors only disillusion the medical profession further. 

Doctors are driven abroad – away from family and away from friends – to restart their roadblocked careers when they should be flourishing here at home. This all risks the delivery of safe and effective medical care and must be adressed if any long-term plan is to succeed. 

The first big shift will move care from hospitals to the community. The drive to establish a neighbourhood health service will have major implications for GPs and their patients. 

Remember, general practice is the most efficient part of the health service. This is despite being scape-goated and neglected by successive governments, resulting in us having a smaller GP workforce today than we had in 2015. 

Doctors told us, if we want to bring back the family doctor, the Government should invest in the family doctor. Proposals to create new, sprawling Integrated Health Organisations are causing huge anxiety, with nine in 10 GPs who oppose their creation telling us that this plan poses an existential risk to the partnership model. 

Two thirds of GPs also believe the proposals in the 10 YHP will reduce the financial stability of their practice. Three quarters believe this will be to the detriment of patients.  

For a plan that wants to bring back the family doctor, alarm bells are sounding across general practice as to whether this will deliver for primary care or risk undermining it at such a crucial time.  

We need clarity and honesty from the government about how any shift in resource will avoid destabilising hospitals while guaranteeing that general practice gets what it needs.  

Make no mistake ... this will be tricky, delicate work. RB, a new workforce plan is important. But doctors remain concerned about announcements about reducing the number of doctors that previous models have suggested will be required. These concerns are only exacerbated by uncertain financial backing and unclear underlying workforce assumptions.  

It is imperative that transparent and independent modelling is published by the Government to allow the necessary scrutiny of any proposals so that doctors and patients have confidence that we won’t be facing another workforce crisis in the future.  

Any modelling will need to explain how fewer staff will be able to deliver more care through Neighbourhood Health Centres, open 24 hours a day, 6 days per week.  

When half of respondents to our survey told us that workforce shortages and a lack of training places were one of their top three concerns, we surely cannot expect that even the slickest AI and the most impactful preventative programmes will fill that gap.  

We have all seen the public scandal created by replacing doctors with physician assistants.  

The secretary of state acted by commissioning the Leng review, and although Professor Leng should have gone further by calling for nationally agreed scopes of practice, the secretary of state accepted her recommendations in full. 

The NHS must learn the lessons from the dangerous way the PA role was introduced and expanded across the country, otherwise it will repeat the mistakes of the past, mistakes that tragically led to patient harm and even death.  

Unfortunately, the 10 Year Plan’s ambition to ‘train to task’ shows that learning lessons is not something the NHS does well. 

Training to task is based on a flawed understanding of medical education. Medicine is truly far greater than the sum of its parts. Failure to grasp this will be to the detriment of patient care; our patients deserve and benefit from the unique skills of highly trained doctors.  

Medicine is safety critical and under no circumstances will the BMA accept policies that, tacitly or otherwise, replace doctors to the detriment of patients.  

What of the second shift, from an analogue to a digital NHS? Keeping up to date with new technology is important, for sure, but too often the NHS can’t get the basics right. Over a quarter of respondents told us adequate IT and estates are a major concern for them and that these need fixing.  

This will need investment alongside the introduction of emerging technologies – which - by the way – respondents are clear need to be well regulated.  And while the majority support the introduction of a single patient record, 63% fear the loss of patient trust if its introduction results in government agencies having control of patients’ data. 

Even more are concerned about the security risks from sharing confidential patient data across settings. The third big shift is from treatment to prevention. There is broad agreement with measures set out in the plan on prevention – 94% for example support its ambition to address key drivers of ill health.

Of course, a real shift towards prevention will require investing in decimated public health functions and public health staffing.  

It will require an independent voice for public health at every level of the health service ... a voice that is fundamental to local commissioning decisions ... a voice that is free to speak out.  

Over the last 10 years we have seen the proliferation of plans. We’ve had long-term plans and forward views. Workforce plans scotched by unfunded commitments. Plans for general practice scuppered by collapsing GP numbers. Public Health restructured but its funding then cut.  

Initiatives undermined by falling morale and burnout, as vacancies rise, as money is tighter, as pay is eroded. If the Government is serious about renewing the NHS, it must urgently address the crashing morale of its staff. 

RB, we want the very best for this nation, for our patients, for our families and for our children. We are not just doctors;  we are patients and relatives and carers too: we are not opposed, or indifferent, to reform. We share the goal of bringing back our country’s health service from the precipice where it teeters today. Avoidable deaths are mounting and it cannot carry on.        

This moment no doubt needs a plan of action. It requires sustained and unyielding effort – with sufficient staff and funding, and building on what already works. But this effort cannot simply be put on healthcare workers as it too often is. We can’t just optimise our way out of this crisis or become more productive at slowly collapsing.  

We can no longer accept that it is doctors and nurses who must toil relentlessly to keep this country’s health service from tipping over that edge. We need the government to step up and fulfil their promise.  

Today, as the voice of the medical profession, we will decide whether this plan does, in the words of the Secretary of State, have our fingerprints over it.  

Whether it speaks – genuinely – to this moment of crisis.  Whether its remedy is correct, or not – even if we agree with its ambition. It is no longer enough to publish a plan; the Government knows it must do the hard work of making these shared goals happen.  

It must understand the reality on the ground. It must listen to the voices here today. If we don’t get this right, in ten years’ time, we won’t be discussing another plan, we will be lamenting the demise of what was another Labour Health Secretary’s hard won creation. 

And if that happens, the old shadows will quickly descend – illness, disease and suffering. And ultimately stabilising and renewing the NHS, is the task that lies ahead for this Government and for us.

So RB, we must, together, get this right. And we must now get to work. The health of our nation depends on it. 

Thank you RB.