Speaking shortly before the new contract was concluded, Brian Butler, director of comms for the doctors' union, the British Medical Association (BMA), admitted the organisation is going through its most turbulent period in 20 years.
The image of GPs, so long seen as pillars of the community, has taken a battering with stories implying that they are overpaid and under-worked.
Butler, a man who prides himself on his loud, working-class Northern persona, takes no prisoners while defending his constituency (he confesses that his colleagues are worried what he might say during this interview). His staffers have accused their opposite numbers at the Department of Health of painting an ‘unfairly negative' image of GPs to journalists.
Hours after the new GPs' contract was announced, Butler issued a release making abundantly clear that doctors are extremely unhappy with the manner in which the deal was done and have no confidence in the Government's handling of the NHS.
The 58-year-old admits to feeling some relish at the role he is now in: ‘I always like being in the eye of the storm. It is fun because you always have to think on your feet.'
But he does acknowledge that the game is more complex than the media war might suggest.
‘MP Ken Clarke has said the BMA is the toughest union he ever dealt with, and I take that as a compliment. We are quite good at shouting. The challenge is trying to get the best deal you can, while also being a strong trade union prepared to stand up for your members.'
There is more than a little irony in his role goading Number 10, for he is a government comms veteran who has spent sizeable tracts of his career advising the likes of Jack Straw, David Blunkett and Edwina Currie on how to avoid the type of media attacks he is currently
Like any purveyor of crisis media relations, he has specialised in trying to be prepared for the next onslaught. But even Butler could not have anticipated the enormity of September 11th, which occurred while he was heading comms at the Home Office.
He describes, with remarkable calm, watching the events play out on the TV from a bunker beneath 10 Downing Street in a meeting of the Government's Cobra emergency committee.
‘We met with the PM and he said: "Tell me it is not going to happen here," and we replied: "We cannot tell you that." So we closed London airspace for a day and a half.' Butler was put in charge of comms for the new counter-terrorism unit. The Government had to reassure the public that its actions would protect them.
He and Mike Granatt, the then head of the Government Information and Communications Service, set up the media emergency forums, establishing rules of engagement between journalists and the emergency services in the event of a terrorist attack.
‘Many ministers have no political antennae for these things. You tell them people might die and all we can do is warn them about it, and their political sensitivities say that is not an acceptable answer to give.'
Former special adviser to Jack Straw and current Euro RSCG Apex Communications executive director Ed Owen worked with Butler in the late 1990s at the Home Office. He says that during a time when ‘spin' was hitting the headlines, Butler was the complete antithesis to the young, flashy PR executives on the scene. ‘He is old-school.
But he is professional and has extremely good judgement. He could give ministers wise counsel on difficult and unexpected issues.'
But Butler, a keen amateur actor, believes that his desire for playing devil's advocate with ministers in order to best prepare them may have hastened the end of his government career:
‘You are there to spot the things that other people have not. You are the angel of death, the person who always sees the downside. But people start to ask whose side you are on.'
After a year in his anti-terrorism job he began to feel that ministers were not listening to him and he left for the BMA: ‘There was a growing tendency for [media advisers] to be afraid to give advice. I think that is disastrous'.
At the BMA he has found a far greater respect for the comms function: ‘Doctors are used to the idea of taking professional advice. They do not always agree, but they are prepared to listen.'
Butler is now looking at how the BMA can better communicate with doctors, conscious that the union is competing with media such as The Guardian and medical titles such as Pulse and GP for latest developments. He is about to launch a channel on YouTube and wants to be able to post news quicker on to the BMA's website as ‘we cannot afford to be second'.
Doctors have traditionally been ‘wedded to print' as a comms channel but, says Butler, some of the younger ones are now sufficiently adept with their BlackBerrys to be forcing through change.
He is in the final stretch of his career, but Butler retains a childlike wonder at the jobs that have come his way, and not just in Government. A stint at Lloyds Bank brought him dealings with
Richard Branson and Robert Maxwell, shortly before Maxwell disappeared over the side of his yacht. (‘A strange man,' says Butler. ‘It was interesting.')
‘I think this is probably my last job. But you never know when the phone is going to ring...'
2003 Director of comms, BMA
2002 Director of counter-terrorism comms
1998 Director of comms, Home Office
1993 Government's deregulation taskforce regulator
1988 Government and media relations manager, Lloyds Bank
1986 Media adviser to Health Minister Edwina Currie
What was your biggest career break?
Moving to London in 1986 to become media adviser to Health Minister Edwina Currie. A month previously my wife had left me and I had a serious car accident. But out of that negativity came a new job and a new start. It was my first step on the Whitehall ladder. I never looked back from that point. I guess I should be grateful for those negative circumstances, which forced me to make a decision.
What advice would you give someone climbing the career ladder?
Do not plan too far ahead. You need to be alert to unusual opportunities. You also need to make sure that the people who matter know how good you are.
Who was your most notable mentor?
Mike Granatt, Luther Pendragon partner. He was my boss at the Home Office and also later at the Cabinet Office. He managed to get us both arrested on a terrorist exercise at one point.
We agreed on almost everything - especially the priceless propriety of civil servants.
What do you prize most in new recruits?
What stands out most is excitement, a capacity for new ideas and ability to question the status quo. Also an appetite to get stuck in.