While the full impact of the Health and Social Care Act has yet to be felt, the government's response so far to the problems facing the NHS has been "inadequate and divisive," and cost improvement programmes are "cutting resources to the bone," according to the BMA’s chair of council, Dr Mark Porter.

Accusing Ministers of "building a Byzantine system that no-one wanted," Dr Porter has warned that the NHS will fail unless doctors, other healthcare staff, patients and their families are listened to. Medicine is becoming a profession "on the edge" as doctors try desperately to deal with the "sheer, unparalleled scale of demand," said Dr Porter, giving his first speech as chair of the British Medical Association (BMA) UK Council at the BMA annual conference in Edinburgh.

 And, he added: “a medical profession on the edge means a National Health Service on the edge." 

He acknowledged that he profession is "painfully aware "of the funding restraints on the Service, and that it may have escaped the kind of swingeing real-term cuts that other departments will suffer when the government publishes its Comprehensive Spending Review on June 26. 

However, he added: "the claim that health spending is protected rings hollow when we face rising demand, new treatments to pay for, and virtually every NHS organisation is suffering year-on-year cuts."

Moreover, according to the results of a new survey which were presented at the BMA conference, 89% of doctors have faced barriers or obstacles when trying to make changes or improvements in the last year.

The main barriers which they have faced are: - lack of time and capacity (51.3%); - financial constraints (39.2%); - insufficient managerial support (39%); and - too much bureaucracy (34%), according to the findings of the BMA's UK-wide Omnibus study.

The survey also reveals that, despite the government's pledge to rid the NHS of wasteful bureaucracy and give them more control, 65% of doctors feel less empowered than they did a year ago, and that 70% consider their experience at work to be either "worse" or "much worse" now than was the case a year ago.

81% of the doctors told the survey that their work pressures now are either "high" or "very high," with the top pressure being meeting patient activity levels, where 89% say the pressures are "high" or "very high."

The NHS is now approaching its 65th anniversary. According to the doctors responding to the survey, what is needed to keep it going for another 65 years are: - greater integration between health and social care (48%) - better management of activity (44%); and - less emphasis on competition (33%).

"If the NHS is to survive another 65 years, there must be a clear recognition that we are reaching boiling point with patient demand," said Dr Porter, commenting on the survey findings. He also called for a greater focus on integrating health and social care, "rather than the continuing obsession of having a competitive market in health."