Once again the British Medical Association (BMA) is rattling its scabbard and threatening the possibility of an exit strategy from the NHS if it doesn't get its way over the proposed extended surgery hours.

I'm old enough to remember Nye Bevan's claim that, in order to get the doctors' trade union to accept the NHS, he had to "stuff their mouths with silver".

The BMA, while doctors remain independent providers, is undoubtedly the most powerful trade union in the country - as the editor of The Lancet pointed out during the last round of pay negotiations.

One day we may have such a surplus of doctors that the BMA's threats to leave the NHS will have little effect.

In France , of course, doctors are employed by the state.

  • RG Jenkins, Welbeck Avenue Hove