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.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk
READERS' COMMENTS [8]
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Jaimie, I thought you would have chosen the headline ‘BMA on trial’ like the brilliant piece you wrote about GMC a few days ago .
This is my take on this current situation of BMA/GPC concerning its first female elected GPC chair:
(1) Sexism and racism :
* A lot have already been said as far this case is concerned. Furthermore, one must also focus on the fact that our lady, Dr Farah, is also non-Caucasian and not a GP partner.
* I accept an argument that colleagues outside the inner circle of GPC did not have the full details of the case. If anything, like the recent case of MPTS versus Dr Arora, I will stress the importance of reading the transcripts and evidence from both sides through independent inquiries. And independent inquiry is never straightforward. One cannot underestimate how difficult for Sue Gray to complete her report for Partygate. The most egregious aspect of this BMA/GPC case, as our information goes so far, is two already existing reports (one conducted by a QC barrister in 2019 with recommendations and another by LMC recently) both converging to the same conclusion with evidence of marginalising women and ethnic minorities. It begs the question of whether we are in fact dealing with Institutional Discrimination (including racism)? And you wondered how far reaching this problem has gone in our presumably civic, open society. We have already witnessed notorious examples from our regulatory institutions (as well as academic ones, not to forget the controversy around MRCGP examination is perhaps still in the background)
* Another intriguing and hypothetical question also arises in my mind, ‘What would happen to a colleague openly declaring his/her sexual orientation (referring to LGBT) was elected to a senior position in BMA/GPC ?’
* We let our differences and disputes ferment into confrontation and discrimination. With spices of prejudice and arrogance , we treat each other in harms way.
(2)’Old Man Politics’ :
* I think it is important that this label cannot be interpreted just literally and superficially as one would challenge me for ageism. My argument is never about at what age political power was acquired but much more importantly, it is about how long a person with power will remain in the top of the regime? The current US president was near his eighties when being elected. Ronald Reagan was in his seventies as the US president. However, their system of government under its constitution only allows two terms of presidency in total of eight years. And for UK in 20th and this century so far, no UK prime minister had served twelve years or more.
* The reason behind is the concern of absolute power for too long will come absolute corruption. Human being cannot be trusted absolutely when it comes to everlasting power. We need a constantly upgrading system to ensure complacency, hubris and dishonesty do not arrive with power abuse. The power of summit leadership eventually tempts the ‘longevity leader’ to crowd out the best interests of the establishment and its members for the gains of individuals. This applies to all establishments of different sizes, I would argue. For BMA/GP, this ‘old boy culture’ of BMA is reminiscent of the temptation of holding onto senior positions in this institution. Yes, we are supposed to have a democratic system with leaders elected by voters. But it always begs the questions, ‘Is that enough?’ and ‘How can we know the results are ‘’just’’?’
* This then highlight the important principle of liberty and equality are two sides of the same coin of liberal democracy, but they are also exclusive to each other. The common pitfall is one taking the other for granted. Finally, we have justice underpinned by an up-to-date and independent judicial (or tribunal) system. An individual or party should always have the right to appeal or undergo judicial under the name of rule of law. Breaking down of this can lead to miscarriage of justice.
* Today is 4th June and I will never forget what happened same day in 1989 in Tiananmen Square in China and many, especially those being incarcerated in prison in Hong Kong for political differences right now, will not forgive CCP led by Mr Deng ‘s decision to repress the liberal movement led by well-educated young students (true number of life loss remains unknown). At least, one thing Mr Deng had slightly self-corrected CCP was the imposition of ‘Seven up and Eight down’ referring to the age of 57 being first appointed to Politburo Standing Committee of CCP and must step down at 68. But now, the current president had abolished this commonly agreed ‘rule’ and rewrote the constitution so that he can be the ‘longevity leader’ with no limit . We see the same thing happened in Russian government. Thanks to Mr Putin, once again
* As I have written many times before, 21st century politics is about honesty, transparency (not fake and pretentious) and humility. And of course, the opposite of the fundamental principle is seen in autocratic regimes or illiberal democracy, and we have already witnessed tragedies in Ukraine.
(3) The Keep did not fall because of ferocious enemies attacking outside but sanctimonious hypocrisies leading to implosion. At a time when we are facing a government with its politicians caring only the next election (local and later general) , the decree ‘Command and Control’ in NHS bestowed them additional power to push all frontline colleagues beyond natural limit unrealistically , capturing the zeitgeist of this historic post-pandemic era namely, recovery with tremendous amount of demands . Colleagues are leaving the frontline every day potentially breaking the system beyond repair.
We , medical professionals , all need a trustworthy , truly transparent and liberal (maintaining equality same time) organisation big and representative enough to fight against our common enemies. This infightings within BMA simply must stop
(4) For representation, I always want to quote the Chinese saying,’ the waves from behind are pushing those in front on the Yangtze River’. The young ones are pushing the older ones from behind to go forward. And one day, the younger will become the older and the circle of life goes on. Evidently, many young colleagues had chosen to be GP sessionals and 47% of the qualified workforce in England are sessional GPs. Then GPC must face this reality and make drastic changes to respect their choices and best interests. I believe there is a way to find harmony between GP sessionals and partners, if there is a will. But first of all, this ‘old boy culture’ must be eradicated. Dr Nagpaul , I think you should take a different approach on this matter decisively and definitively . Pride and prejudice are our worst enemies .
The youth is never wasted in either the young or the old , but we must allow and create opportunities to prevent youth to be wasted .
(5) Change of tone for some fun for my guilty pleasure. For those who have been following British Got Talent this year should be aware of this lady named Loren Allred who was actually the behind-scene singer for the actress Rebecca Ferguson in my beloved musical movie ,’The Greatest Showman’ , in the song Never Enough . I will be a bit disappointed if she does not win in the final tomorrow night (Sunday). She chose the song ‘You Say’ in semifinals two nights ago receiving standing ovation, once again. ‘You Say’ is written and sung originally by a famous Contemporary Christian Singer, as they label in US, called Lauren Daigle . The song and the album won her two Grammy awards in 2019. The lyrics are meaningful but of course, religious as well. I am not adhering to any religion but after all , we should not forget the lessons from discrimination arising from religions(internally or externally) in modern history .
I would like to dedicate this song to you, Farah, especially the last two words at the end of the song ‘I believe’ . I believe we will find a way out of this mess ……….
All the best
Enjoy the Platinum Jubilee weekend
Vinci Ho
GMC 3483114
BMA 7243256
My correction
I should address Dr Jameel or Farah
Who knows.
The BMA disappears up its own fundament, whilst it’s members on the frontline (female,male , whatever ) need an effective union more than ever
And one quote I must use again :
‘’If there is a hard, high wall and an egg that breaks against it, no matter how right the wall or how wrong the egg, I will stand on the side of the egg. Why? Because each of us is an egg, a unique soul enclosed in a fragile egg. Each of us is confronting a high wall. The high wall is the system which forces us to do the things we would not ordinarily see fit to do as individuals . . . We are all human beings, individuals, fragile eggs. We have no hope against the wall: it’s too high, too dark, too cold. To fight the wall, we must join our souls together for warmth, strength. We must not let the system control us — create who we are. It is we who created the system.’’
(Jerusalem Prize acceptance speech, JERUSALEM POST, Feb. 15, 2009)
Haruki Murakami