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Dr Helena McKeown is one of a tiny minority of young women on the GPC and is standing for election to the BMA council ­ she describes life juggling medical politics with full-time partnership

'Helena you can't help, the medical care system has failed, and you can't change that!' So shouted someone who knows me best, when my Father was critically ill last year.

However, being an idealist I have always and will continue to rail against what I see as unjust, or a poor use of limited resources, or dangerous; and it was with safety and not a little self-interest that I began medical politics as a houseman when the junior doctors' committee was brokering an end to 110-hour working weeks.

For a while after, I went from post to post as the BMA's place of work accredited representative and then lay dormant while I had two children during my GP training.

As soon as I became a principal I stood for Wiltshire LMC, but I became really fired up when, having recently acquired single parenthood, I had to pay for childcare in order to go out and be on call ­ which was not tax-deductible. In 2000, when I wanted to send a motion about this to the LMCs conference, there was no enthusiasm for this.

Oddly enough, as a first-time (or quaintly a 'maiden speaker') at the BMA's annual representatives meeting (ARM), I actually found myself speaking against a hospital-oriented motion that would require every small GP practice to provide onsite childcare. There, I found myself passionately speaking out for what we really need, and have continued this into much broader issues since.

The next year I was supported by someone widely known in medical politics, Dr Bob Button, retired chief executive of Wessex

LMCs, to stand for the ARM agenda committee. I saw the Committee as key to getting GP issues on the BMA's action plan.

I also sought help from our local industrial relations officer in resurrecting the Salisbury BMA division, an ongoing task that still causes me a few sleepless nights. However, soon after I joined the BMA's committee on community care, then chaired by Dr Andrew Dearden, contract negotiator and pensions expert. I felt able to ask him to come and tell local GPs about nGMS.

Conference with the kids

My third child, Katharine, was born three weeks before the LMCs conference in 2002 and I took a friend who had childminded for me along to help with Katharine. The BMA has a policy of providing onsite childcare for under-fives or reimbursing additional childcare. So Katharine joined me for some of the motions, came to the supper at the Savoy and cuddled up in my single bed in the so-called Imperial Hotel.

Two weeks later and we were off to the ARM in Harrogate, this time with a husband and five- and six-year-old in tow as well as five-week-old infant. At lunchtime the agenda committee would have a working lunch and Katharine would have a good breast-feed ­ with only Dr John Chisholm, then GPC chair, brave enough to sit anywhere nearby!

By this time I thought I was gaining experience but lacking in skills, and decided to sample some RCGP masterclasses in leadership. If I thought it would be valuable enough I would pay the £5,000 for the complete course.

While on one such course I met a local associate postgraduate dean and later joined her team to help implement appraisals for GPs. My parents had always told me it is better to fight system injustices from the inside than from the outside, and at the time some people felt threatened by appraisal.

It was a pleasure being part of appraisal locally ­ it became a truly formative process, and I still enjoy every appraisal I'm fortunate enough to facilitate.

Using the same logic of ensuring things work from the inside, as an LMC member, I have taken on QOF visiting, in an attempt to keep the promised 'low bureaucracy, high trust' approach!

The RCGP leadership programme gave me the confidence to aspire to the council, which I'd wrongly assumed was only for fellows of the college, with years of research, teaching or examining behind them. It's been a surprise to find there are considerably more women at the council than there are proportionately on the GPC. I wonder if women are more likely to go into deaneries, research and teaching than LMCs?

Maybe there is something about the ethos of the RCGP as leading in quality rather than the GPC being our statutory negotiating body, having to be first and foremost about terms and conditions?

With an increasingly female GP workforce, some of whom are being employed at 'bargain prices' as salaried doctors, GPs must be careful not to have our negotiating position and financial rewards eroded by some people being prepared to receive less for reasons of flexible hours, or by virtue of perhaps being the less important second income.

Expanding my interest in education, I've been elected to the BMA's Board of Medical Education and recently become a GP trainer. I've loved having the responsibilities and rewards of my first registrar.

I spent two years on the LMC agenda committee ­ then heavily pregnant with Olivia, now 18 months, I stood for the GPC, fourth time lucky! 2004 was a vintage year and when Dr Dearden's commitments as chair of GPC Wales led him to stand down as chair of BMA's cross-craft committee on community care, he encouraged me to stand ­ with baby safely ensconced with BMA nanny close by.

Since then I've been busy with Carers UK, the Alliance for Long Term Conditions, patient liaison groups, Department of Health officials with responsibility for older people and paediatrics, Green Papers, White Papers and very thick papers, or rather megabytes.

My partners at Three Swans Surgery have patiently allowed me to flit up and down to committees and my son takes great pleasure in answering the kitchen phone and calling 'Mum, it's Barry (my secretary) from the BMA!'.

That's the wider world looked after. As for my dad ­ continuing to ask from overstretched professionals, all willing to help, has helped to ensure good care for him too.

Helena McKeown is

a GP in Wiltshire and is currently a candidate for election to the BMA council ­ the ballot closes on 13 April and results are due to be announced on 24 April

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