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Gold, incentives and meh

Do salaried GPs need a new union?

Would the interests of salaried GPs be best served by staying with the BMA or finding an alternative organisation? Two parties battle it out

Would the interests of salaried GPs be best served by staying with the BMA or finding an alternative organisation? Two parties battle it out

Salaried GPs can't turn to the BMA in disputes with principals because they feel it will never take a tough line with its own members, says MPU president Dr Ron Singer

The debate about the representation required for salaried GPs should be focused and clear. Let's start with the key players.

The BMA represents the medical profession nationally in discussions with the Government, but it also provides a range of services for its members, including support in contractual disputes.

The Medical Practitioners' Union is a small section of the largest TUC-affiliated union in the UK, Unite. The MPU has always been a radical campaigning body – fighting for a reduction in junior doctors' hours when they were working 100 hours plus a week and to highlight discrimination against ethnic minority applicants to medical schools and for medical jobs. It has also successfully opposed Government health policy and helped highlight the plight of asylum seekers and their often inadequate care under the NHS.

The MPU takes up the individual cases of members who experience workplace problems, often related to discrimination. Its specialty is in supporting the underdog.

So are salaried GPs underdogs and would they benefit from the expertise of MPU and Unite officers? The answer from salaried GPs themselves seems to be yes.

In my experience salaried GPs think that the GP section of the BMA is dominated (numerically at least) by GP partners – the employers – and that GP employees will suffer as a result of a conflict of interest. Unite offers separate representation for its members, who already include a large number of employees at primary care organisations and hospital trusts, such as community and mental health nurses, scientific officers and so on.

Salaried GPs – even those working in larger practices – often feel isolated, particularly when in dispute with their GP bosses. They need to have confidence in their professional supporters. At the moment they feel that ‘robust security walls', as one BMA official puts it, do not offer sufficient reassurance that their interests are equal to those of their employer when both are represented by the same organisation. One GP told me she would not even contact her LMC for fear that its members would not support her.

These are the perceptions of salaried GPs, even if they are not grounded in reality.

GPs have long employed staff, but employing and managing equally qualified colleagues is different. Many partners feel the BMA's model salaried contract is too generous and prefer to offer their salaried colleagues inferior terms and conditions. And salaried GPs ask, if the BMA can't enforce the model contract, how can it support us against our GP bosses who are usually BMA members anyway?

Unite has huge experience negotiating with NHS employers and is likely to be tougher on GP employers than BMA officers can be. Disciplining your own members is much harder than negotiating a settlement between parties.

If the number of salaried GPs working for practices, PCOs and the private sector continues to grow as predicted, the case for supporting these colleagues grows too.

Finally, the MPU has long campaigned for a salaried option for GP principals with all the rights and responsibilities that self-employed principals enjoy. My own practice was salaried to the local PCT for seven years and I know the model works (with pluses and minuses). Only the MPU supports such a model; the BMA never would.

There is a niche for an alternative GPs' organisation and MPU-Unite fits the bill perfectly.

Dr Ron Singer is a GP in Edmonton, north London, and president of the MPU

The BMA already gives sessional GPs a voice at the highest level – splitting off will only divide and weaken the profession, says Dr Vicky Weeks, the GPC's sessional GP chair

About 10 years ago I decided to get involved in medical politics. As a salaried GP I didn't feel my rights were being as fully represented as they could be. Sound familiar?

Back then I had real problems getting recognition for the work I did, and as study leave wasn't recognised, I struggled to get professional development. I felt hard done by, and got involved to improve not only my lot but those of all salaried and locum GPs. A decade later, and after six years as chair of the GPC's sessional GPs subcommittee, I still believe that getting involved with the BMA is the best way to make all our working conditions better.

So am I deluded or misled? Key to this debate is how the BMA deals with individual cases where it represents both the employer and the employee. There is also the question of our power as a single body representing all doctors. Many GPs, remember, will change their contractual status during their career.

The BMA does not support any practice that deliberately exploits or mistreats its employees. We are a trade union, and to offer such support would be completely at odds with our ethos.

When there is a dispute between an employer and employee, different expert advisers are appointed to each side and complete confidentiality is strictly adhered to. These advisers will write letters on behalf of the salaried GP, accompany them to grievance meetings and, if it gets to that stage, a tribunal – everything you would expect a trade union to do for members.

The salaried GPs I know who have used the BMA for these purposes have felt supported. But if you think the BMA didn't represent you as well as it should have, let us know. If we don't know how we are failing, we can't improve. We also provide sessional members with the salaried GPs' handbook, news and advice on job planning on our website and conferences designed to meet their needs. And the BMA's contract checking service is there to ensure their contract works for them.

At a national level the strength of the BMA comes from our unity. Differences are discussed internally in a constructive way so we can present a united front to the Government in negotiations. A separate union for salaried GPs would play into the Government's hands. It can sit back while we attack each other, knowing that a divided profession is a weakened one.

The sessional GPs subcommittee is far more than its name suggests. We have achieved a great deal over the years – from negotiating the model contract (which acts as a benchmark) and achieving pensionable pay, to more recently being involved with revalidation and pandemic flu planning to ensure arrangements are suitable for salaried GPs and locums. Our concerns are listened to and acted on at the highest level. What's more, in Dr Beth McCarron-Nash we have a salaried GP on the GPC negotiating team and she ensures our voice is heard.

We take the issue of sessional GP representation very seriously and are setting up a group to look further into this, nationally and locally. We are aware, as are many LMCs, that not enough sessional GPs are coming up from the grass roots. For salaried GPs to be effectively represented, they need to be involved in medical politics and to see they can effect change. I am proud of what we have achieved, but am the first to admit there is more to be done.

But I am certain that the most effective way to represent the interests of we sessional GPs is by remaining part of a trade union that can represent us at national level and throughout our careers.

Dr Vicky Weeks is chair of the GPC's sessional GPs subcommittee and a salaried GP in Southall, west London

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