British Medical Association

By Dymond, Duncan | New Statesman (1996), October 11, 1999 | Go to article overview

British Medical Association


Dymond, Duncan, New Statesman (1996)


Tony Blair may think it a conservative force, but it has been weak in protecting the health service

The British Medical Association (BMA) describes itself as an independent trade union, claiming to protect its members' professional interests. Its mission statement is "to promote the medical and allied sciences, and to maintain the honour and integrity of the medical profession". As a member, I am supposedly kept up to date on clinical issues, advised on contracts of employment and terms of service and assisted in the resolution of disputes in the workplace. It promises me aid in matters of medical ethics and, as a bonus, will help me with financial planning, guide me on taxation and pensions and provide me with access to preferential personal loans.

The BMA, with its 120,000 members, claims to be "the voice of the profession"; and it is indeed officially recognised by the government and the pay review bodies as the sole representative of all NHS doctors in hospital and community services. It doesn't sound a very sinister or dangerous body, yet nobody was in much doubt that, when the Prime Minister denounced "conservative forces" at the Labour Party conference, Tony Blair had the BMA in mind, along with hereditary peers, fox-hunters, Civil Service mandarins and Labour activists.

The charge is a familiar one, but many doctors may wonder why the BMA should attract so much political hostility. It has always struggled to convey some sort of unity in a profession that has so many squabbling branches and conflicting interests. The stresses of financial and managerial accountability have simply heightened the divisions, leading to internecine squabbles over matters such as ward closures, hospital reconfigurations, the constitution of primary care groups and management of inadequate budgets. While we doctors fight among ourselves, the politicians can portray us as arrogant, self-serving and smug, clinging to our "we-know-best" mentality (not a charge that could be levelled at anybody at Millbank, of course) and stubbornly resisting change.

Yet as a profession we doctors have had to absorb increasing pressures to increase our workload while saving money, find time to train junior staff and carry out audits, attend endless meetings on contracts, continually medically educate ourselves and come to terms with clinical governance, drop-of-a hat litigation and trial by tabloid.

What has the BMA done for its members during these trying times? Well, it has introduced a round-the-clock counselling service for stressed doctors, a sort of in-house Samaritans. Yet on the closures and mergers of the London teaching hospitals proposed by the Tomlinson report in 1992, the BMA has remained silent, lest it be seen as too pro-London. It swallowed the lie that London's loss would be the nation's gain and failed to represent the interests of London's consultants or to heed the argument that London was not oversupplied with beds. As the thrust of Tomlinson was to sacrifice hospitals to give more money to primary care (a promise as bare as Old Mother Hubbard's kitchen furniture), the BMA (two-thirds of whose members are general practitioners) set out its stall to be anti-London and anti-hospital. So much for representing the whole profession.

On the matter of junior doctors' hours and pay, the BMA faced a rebellion when the "good deal" it thought it had wrung out of the government was rejected by the juniors; and quite rightly so. It announced agreement on a new pay structure for juniors before it had been put to the junior doctors' committee.

The BMA claims to protect standards, yet it has not been vocal in highlighting the dangerous consequences of the restructuring of specialist training. The apprenticeship of ten years or more as a registrar and senior registrar often included a substantial period of clinical research. This taught the ability to interpret scientific data with a critical mind and allowed a seamless transition into becoming a consultant upon whom the mantle of final clinical responsibility sat comfortably. …

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