As editor, I’ve often turned my nose up at internal BMA stories. I have always thought what happens in the corridors of BMA House matters little to the average Pulse reader. But writing this month’s cover feature, it became clear to me that it does matter.
According to many GPs close to the BMA, the culture within the organisation remains toxic. There are reports of bullying, sexism, and complaints being used as a weapon. There are competing factions within the BMA’s GP Committee (GPC), which breeds animosity and leaves all sides declaring the committee is ‘broken’.
But the impact goes beyond those directly involved. New people stay away, or leave soon after joining, and priorities are skewed. The negative culture sometimes infects LMCs, which are closer to grassroots GPs. With the issues encountered by the first woman to chair GPC England, it also left the profession leaderless for months.
Poor female representation is the most obvious problem (it is important to note that ethnicity is less of an issue at the BMA than in wider society). Medicine is a predominantly female profession, yet – while the BMA points to an increasing number of women taking up senior positions – at the most recent BMA Council elections, only 38% of members identified as female (up from 37.5%, the BMA hilariously proclaimed). At the GPC, only 38% of voting members identify as female, compared with 58% across the profession.
This affects priorities. Take the gender pay gap: a Department of Health and Social Care report found that, after adjusting for hours, the gap was 19% for hospital doctors, 15% for GPs and 12% for clinical academics. There are, of course, underlying societal reasons, but studies show the gap is worse than in other professions.
It’s no coincidence that the committees doing most to take up this cause are the Junior Doctors Committee and the Sessional GPs Committee – both of which are predominantly female (and among the lower-profile committees). I can imagine that an issue affecting men equally – like pensions, for example – would get a lot more attention across the BMA.
Talking of pensions, it is fair to ask if too much emphasis is put on lifetime tax allowance – which affects older male consultants and GP partners – compared with the annual allowance, which is more likely to affect younger females.
Even the BMA’s commitment to the independent contractor status might reflect the lack of female presence. But because the GPC isn’t representative, we don’t actually know what the profession really thinks about partnership.
Of course, the BMA will never have perfect representation – for a start, it will always be tilted towards the cohort of GPs who want to be involved in medicopolitics. But it can be more representative than it currently is.
Fresh blood for the GPC is vital, yet we’ve seen how female GPs in particular are deterred by the culture. Experience helps, but far too much store is set by it. GPs unburdened by past experience might tend to be more radical (it was new GPC members who pushed for industrial action, for example). Maybe radical ideas wouldn’t work, but we know one thing – the current approach hasn’t led to a contented GP workforce.
As the cover feature says, there are positives. There is new leadership, which may bring culture change (and I should say at this point, as a conflict of interest, I have worked with one of the new co-CEOs of the organisation, and can say if anyone can address the culture, she can).
The fact we are having these conversations is a good thing. But the whole organisation needs to step up if general practice is to get out of the crisis it is currently in.