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The British Medical Association are never far away from the headlines but what is their real game? In their latest In the Loop podcast, Niall and Roy have an in depth discussion with Dr Tom Dolphin the BMA chair who leads one of the most powerful trade unions in the country, if not the most powerful.

In a revealing exchange Tom reflects on the growing militancy of doctors and their willingness to strike, as well as the changes affecting General Practice which for some GPs is making their lives less satisfying and more transactional. But he insists the partnership model, in which GPs run their own businesses, can survive if it is properly supported, in spite of many younger doctors choosing to take on salaried roles.

Tom  doubts the value of revalidation, the system that requires doctors to show they are competent and up to date and he blames the NHS for making doctors undergo pointless statutory training as part of that process. He is deeply concerned at so called ‘doctor substitution’, whereby tasks once performed by doctors are being carried out by professionals with new roles such as Physician Assistants, and he reveals talks are underway with the Royal College of Nursing about the expanding roles of Clinical Nurse Specialists.

As the seemingly existential duel with the UK government goes on, this is a chance to hear the leader of Britain’s doctors as he reflects on the battles ahead for the BMA, but also to hear his take on the wider and fundamental challenges facing the medical profession. Tom insists the BMA and the UK government are aligned in their ambition for the NHS, but there is little sign in this exchange that the union will backdown. Indeed he issues a warning that if things don’t go their way, further strikes are possible from other doctors including consultants, the most senior doctors on the front line.

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To start their 2026 podcasts, Niall and Roy make a departure from their usual focus on the politics and management of the NHS, and explore the worrying state of our young people.  The awful reality is that youngsters in the UK appear to be unhappier than nearly all their European counterparts. 

Their first guest of the New Year is David Gregson an entrepreneur and philanthropist who has embarked on an ambitious and innovative programme called #BeeWell. Its aim is to improve the wellbeing of young people throughout the country, starting in Greater Manchester and a few other areas of England. Working with the Mayor, Andy Burnham together with schools, local authorities and the NHS, the architects of the #BeeWell approach already claim to be having a significant impact, affecting the lives of thousands of young people. 

But can this programme, which demands action and a mind-shift from statutory and voluntary services, really be the catalyst to change the prospects of the next generation? 

In a fascinating exchange, David Gregson points to weaker family relationships, restrictions on child freedom, and the fact that adults often no longer understand the world in which their youngsters live. He applauds moves by the UK government to raise the profile of youngsters’ wellbeing and its support for idea of conducting surveys in every school, but he wants them to go further and faster.

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Niall Dickson CBE and Roy Lilley with their latest guest Dr Charlotte Refsum 

In their latest In The Loop podcast Niall and Roy lock horns with Dr Charlotte Refsum Director of Health Policy at the Tony Blair Institute. In a frank discussion Charlotte a former GP,  reveals how the former Prime Minister is still closely involved in policy development and she lays out the stark choices facing the NHS if it is to survive in the face of the enormous challenges it currently faces. 

Charlotte is a former GP who has specialised in health policy. She worked for the consultancy firm KMPG and has been involved in supporting change in 25 countries.  She contributed to the government’s NHS plan and has worked with Sir Patrick Vallance and Sir John Bell on technology and how the arrival of the AI era will transform health and care.

In the podcast Charlotte defends the Institute’s links with big tech companies and non- democratic governments and insists she and her colleagues have editorial independence and have never felt under any pressure to write anything or hold a view because of those relationships or funding. 

What follows is a frank assessment of the current government’s strategy but hard questions about what will be needed to implement the changes needed and whether the absolute priority, which concentrates so much of its resources on older people with long term conditions, is justified. 

Charlotte suggests the current budget may be all we can afford, and in her view the NHS needs to find ways of living within its means. That will involve thinking like an insurer, assessing future risks and taking prevention much more seriously. And there is also  talk of copayments for some new treatments for those who can afford it and the need for the NHS to start decommissioning some services if it is to embrace the technological revolution that is underway.  And she suggests we need a revolution in primary care. 

As for the professions, she suggests the impact on doctors and others is uncertain but will be profound.  One of the changes she identifies is how new technology will continue to undermine the asymmetry of information that underpins the professions and how it will become easier and cheaper for people to seek advice from elsewhere. But she adds, that does not mean a dystopian future where we send out someone with an NVQ and an iPad to get and manage complex cases! 

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Niall Dickson CBE and Roy Lilley with their latest guest Rob Webster CBE 

For this next edition of In The Loop podcast Niall and Roy come together with Rob Webster one of the most prominent NHS managers and a huge advocate of integration. Rob heads up the West Yorkshire and Harrogate Health and Care Partnership an integrated care system.  And like every other system in the country he is grappling with a huge financial challenge, a big reorganisation, redundancies and staff threatening industrial action. So how is he managing as he faces a 45% reduction is his workforce and key staff in an angry mood? 

Rob reveals this is the most frustrating period in his 36 year career with enormous pressure on everyone and he admits it is causing harm to his staff.  But he insists it will not distract from the work. While he acknowledges the difficult financial position, he says the transition is incredibly difficult, supports the aims of the reorganisation and believes that close working relationships between health, local authorities and the third sector can and will deliver meaningful change.  

He says the NHS must put its people first and argues that staff have quite rightly become dissatisfied and that the job of NHS leaders is to do something about this. He notes how painful it has been to see the attrition of standards over the past fifteen years but suggests this can be a period where the NHS has to recover and transform services.

Niall and Roy remain concerned about what can be achieved given all the headwinds but here again is a leader who says they can make progress.

This podcast was recorded before the government announced the go-ahead for widespread redundancies in ICBs and NHSE.  Speaking at a Providers conference on 12th November the Secretary of State said; 

‘...Funding arrangements [for voluntary redundancies] have been agreed with HM Treasury and will be from within the existing funding settlement. We will not be cutting any investment to the NHS frontline. Further detail will come forward in the coming weeks.’

It is widely anticipated that NHS organisations will be permitted to overspend budgets in the current year and the amounts reclaimed over subsequent years through efficiency savings.

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In their latest podcast Niall and Roy engage with Sarah Woolnough the Chief Executive of The King’s Fund, one of the country’s leading health think tanks. In a frank discussion, Sarah defends the role of think tanks and laments the government’s failure to embrace public health and prevention in its first year in office. 

She is highly critical too of the decision to kick the social care can down the road and says the Fund is now exploring radically different ways it could be funded, including social insurance.

She is no fan either of the current reorganisation, arguing that she would have done it differently and quoting NHS leaders warning that it is already a major distraction. And she calls on the government to be honest about what it can and cannot be achieve within current funding constraints.

Sarah reveals one of the most powerful moments she has had since joining the Fund: listening to leaders revealing the moral injury they have felt for not being totally transparent about their financial position for fear of being placed under greater performance scrutiny. 

And while she wishes pharmaceutical bosses better understood NHS funding challenges she understands their ‘immense frustration and anger’ because they feel the government has led them up the garden path.

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In their latest venture In the Loop, Niall and Roy turn to mental health and conduct the first interview with Claire Murdoch,  NHS England’s outgoing mental health director since she dramatically resigned earlier this month after nearly ten years on the job.   

In the podcast, Claire says she quit because she felt she no longer had political support and reveals her dismay at the failure of the new government to maintain the share of NHS spend on mental health. 

In a strong defence of what has been achieved on her watch, including more than doubling the number of professional staff working in child and adolescent services, much improved access for young people, despite a huge increase in demand, and great progress on a nationwide roll out of mental health support in schools. 

Looking forward, she says the share of NHS spend has been phenomenally helpful and must be protected and that as far as she is concerned it was ‘job begun not job done’. 

But this discussion also reflects the reality of mental health care in England today with services desperately struggling to meet the explosion in demand and with patients of all ages unable to access the support and treatment they need.

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The latest podcast from Niall and Roy sees a somewhat different take on the current state of the NHS from Dame Jennifer Dixon, the longstanding and respected Chief Executive of the Health Foundation. 

Jennifer, who once practised in paediatrics before moving into public health, accuses the government of being disrespectful and menacing in its approach as it seeks to reform the service and argues that the system needs to use its principal asset which is human capital.  She also questions whether it will be possible to deliver all that is being promised, arguing that while technology will help it is possible to be unrealistic about what it will achieve.

Dame Jennifer also questions whether the current approach to prevention will work suggesting that there is a limit to how much the NHS can do given its funding constraints and she warns that if autonomous Integrated Care Boards could go upstream and spend funds in that way it could be at the expense of basic services. She says that while we are not there yet, if improvements don’t come fast enough, we may get into a situation where we need to look at getting much more money into the system from some other routes.

On her own profession, she says she understands why young doctors are angry but reveals how she saw at one hospital how disrespectful they were to their chief medical officer, switching off their online cameras and putting barbed comments in the chat box. 

Jennifer calls for much more practical support for resident doctors but predicts that technology will mean more tasks will be protocolised and that as a result in the future there may be a need for fewer physicians, with those who are there working at the top of their licences. 

The next five years she says will be the most critical in the NHS’s existence.

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