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GPs need a radical new union

Huge pay rises for senior BMA staff who have not adequately fought GPs’ corner could be the last straw for the profession, warns Dr Tom Nolan

Last month, GPs were shocked to discover that the BMA had awarded senior figures pay rises of up to 137%, including doubling chair Dr Mark Porter’s salary to a staggering £172,000 (although he hands some of this back).

At a time when the profession is desperately in need of hardworking and honest leadership the news came as a blow to GPs in particular, who have suffered successive years of frozen pay and increasing workload.

Just a few weeks later, the union let GPs down again – this time with its muted response to the so-called ‘new deal’.

The BMA is a respected historical institution that represents us all. But your strengths can also be your weaknesses: the BMA’s proud history and broad representation are exactly why GPs need an alternative, and this is one of the union’s two major problems.

Like many venerable institutions, the BMA keeps doing what it’s always done, more or less. It can’t afford to be too radical or call for fundamental change as that could jeopardise its reputation. GPs may not want radical change either, but merely working to preserve the status quo won’t be enough in the long run. A trade union with no history or reputation to protect would be free to express opinions and ideas that need to be aired but that we, the Government, and the public wouldn’t expect to hear from the BMA.

The only alternative existing union for GPs is the Medical Practitioners’ Union, which is part of UNITE, the nation’s largest union. It is not tied to its history in the way the BMA is but we don’t hear from it enough.

Pressure groups like Resilient GP and the National Association for Sessional GPs (NASGP) prove that it’s not essential to be a trade union to promote radical ideas, as they’ve shown by empowering more GPs to say ‘no’ to patients.

But how much more potent would that message be, though, if it were backed by a membership organisation that was prepared to take action to make this part of NHS policy?

The second problem the BMA faces is that it has to represent all doctors. That’s what it was created to do, and it’s what its history and stature requires. It represents partners, salaried and locum GPs, newly qualified GPs, almost-retired GPs, and even GPs who have actually retired (if only for a day). It represents different ethnicities, cultural backgrounds, sexualities and a broad range of political views. This is a good thing. From my experience of sitting on the GP trainees’ subcommittee a few years ago, I saw a democratic system that was open to new ideas and voices. Just go and speak at a BMA conference and even if it’s your first time and what you say makes no sense, you’ll still get a round of applause.

BMA hamstrung

Unfortunately, while the BMA may have a system to represent the views of the many tribes within general practice, when the views of one group conflict with those of another it can’t fight for both. Subcommittees, conferences and conversations in hotel bars allow debate about conflicting views, but ultimately the BMA has to settle on one policy for each issue.

This is most starkly illustrated by the directly competing interests of partners and sessional GPs. Not all salaried GPs feel their concerns are being well represented by the BMA, and some worry they are overshadowed by issues that mainly affect partners.

Nor is it clear how helpful the BMA is at a local level in negotiating pay and conditions for salaried GPs. A union that salaried GPs see as their own could succeed where the BMA struggles. Indeed, how much of the rise in rates of burnout can be explained by salaried GPs being asked to work beyond their contracted duties?1 It seems improbable that the BMA would support a policy of salaried GPs working to rule, given the effect this would have on partners, but a separate union could.

We are seeing organisations like the NASGP and Resilient GP grow in status. A surge in support at grassroots level is all that would be needed for a new union for GPs to form. The ingredients for this are there: a profession at its wits’ end in the face of unchecked demand and a Government that appears unlikely to save us, against a background of internet forums that can bring likeminded GPs together.

In 2007, the BMA’s role in the MTAS fiasco resulted in junior doctors getting a new voice through RemedyUK. It feels like something similar is around the corner for GPs, and a new union would be just what we need right now.

Dr Tom Nolan is a GP in Brockwell Park, south-west London


1 Pulse. Revealed: the rising tide of GP burnout.

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Readers' comments (18)

  • I'd rather be a member of UNISON to be honest

    What good is a union that is certain never to go on strike for fear of 'rocking the boat'?

    We need a union with teeth ...that can bite back

    We currently have a tired old Chinchilla....when what we need is a well trained and focused Alsatian

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  • Vinci Ho

    One thing I would always say about a long established instituition or organisation is , it always run the risk of overlooking the feelings and opinions of the younger generation coming through the door. The world is changing everyday with new ideologies. The creation of Internet has both its success and demise .
    I always warn myself of being more stubborn as I am growing older . That is exactly the prelude to all these blind spots ignored by many those in hierarchies . In addition , the 'baggage' of being afraid of denting its reputation in any movement of dare ,demonstrates the true meaning of 'an establishment'.
    In a battle against establishment , it is not quite logical for the fighters to become an establishment themselves. They need a leadership with genuine fighting spirit and tactics.
    Pressure groups are products at a critical time in history . They represent dissatisfaction to the establishment(s) and are meant to be the protagonists for changes. Problem is they also have the risk of internal conflicts as all new, radical ideologies arise fast and furious.The analogy of further cell divisions is so often apparent. Indeed , history rewrites itself time to time.
    My feeling is a mixed one at times like this as quoted in Charles Dickens' famous lines :
    It was the best of times , it was the worst of times ........

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  • The BMA has been utterly useless for GPs, both at National and Local level in my experience, too obsessed with saving the NHS to save GPs.
    With a major recruitment crisis, GPs should be in a strong position to just say no, but ever more nonsense is dumped on us.

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  • Our pay has fallen by 25%, our workload is up 75% in the same time. In a recession, pay falls because work falls. But we have no problem with work, plenty of that.
    Legal aid here in NI made some firms over £2 million and some barristers over 1 million.
    Management Consultants get over £2000 a day. I dare say they have no more qualifications than us.
    The GPC keeps bleating about how bad everything is. We know this already. Think of some things to do - such as an absolute right to close lists when we chose for our safety. There cannot be another Union in the world that are forced to work unsafe hours - look at the Imposed Contract [ a complete contradiction in terms] . Define guidelines for safe practice ie how many patients to be seen a day.
    Why does not Chaand or Vautery ever talk of doctor safety? Gongs, no doubt.
    The BMA has always been an effete organisation. It will always be so.
    It COULD begin to define safety levels or doctor patient ratios tomorrow. The fact that it does not is eloquent testimony to underhand machinations- as Sherlock Holmes said of the dog in the nighttime - the dog did nothing in the nighttime - that was the curious incident of the BMA>
    I have done over 700 of 80+ hour weekends with 2 or 3 hours sleep many, many times as witness to that.

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  • Yes we need a new Union - something like the European Union

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  • The story about the salary is spin and Tom Nolan should not have written it in this populistic way; it's Daily Mail style. The guardian had to issue corrections:
    I agree with the frustrations Tom Nolan shares, but is the solution really to make the BMA the scapegoat? With his calls for a further union to represent salaried GPs only he is pitching partners against Salaried GPs. What we need is unity within all GPs and actually for all Doctors to see themselves as One Profession. Driving more and more wedges between us will do more harm than good. Jeremy Hunt will probably love it: divide and conquer. Believe it or not, GP partnerships and partners face a far more existential threat at the moment than the fairly adjustable, flexible salaried workforce. If partners have to give up salaried GPs will suffer as a consequence. Therefore, we ought to work together to tackle the threats to primary care.
    Unless, Tom Nolan does not care whether he is employed by a GP Partner, the local financially failing hospital trust or any private provider and it is all the same to him. Good luck with that then.

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  • I disagree primarily on one issue - the need for a union at all. We don't need a body corporate, or a legal framework, an institution, an a-political chicken or a swanky HQ in London.

    What we need is a clear, concise message, and a unified movement. Forget the politics, and the structures. It needs to be less 'Brussels Bureaucrat' and far more like Martin Luther-King - a radical approach to conveying the message of what we dream of for the NHS that the nation can get behind.

    People must reaslise that we believe more in the NHS than HMG who are trying to flatten us, and that we are fighting for Bevan's vision, not our own position or prosperity.

    The average smartphone in your pocket is more powerful than the computer they used to put a man on the moon. Its not something new we need, but a new way of using what we have to greater effect.

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  • An essential component of GP representation is the public image . And specifically to effectively counter negative policy. The BMA have failed to do this. This is one reason I regrettably have cancelled my direct debit.

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  • MPU

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  • Let us take this idea forward; Let us also consider taking on board the hospital doctors to make it a complete body for doctors. Members must be ready to undertaken any action in the interest of members.
    At present doctors are doing so much of professional and clerical work; and it must be recognised financially.
    Government is using doctors to suppress doctors via newly formed CCGs. Doctors in CCGs decide about other doctors what they must be doing while competing with them; a clear conflict of interest.

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