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BMA’s full response to Pulse investigation into sexism and culture

BMA’s full response to Pulse investigation into sexism and culture

The BMA sent a lengthy response to Pulse’s allegations. We are publishing it in full, although we have removed the responses to allegations we haven’t published

Pulse: The chair of GPC England took sick leave following reports of sexist comments and culture at the BMA. Several GPs have said there is a ‘toxic culture’ in GPC and the BMA as a whole.

Incoming BMA joint chief executive officers, Rachel Podolak and Neeta Major said: ‘We are very concerned to see these reports of sexist comments directed towards Dr Farah Jameel. Sexist comments of any kind are of course unacceptable. We can confirm that Dr Jameel has raised concerns about the conduct and culture she has experienced within the BMA and the impact that this has had on her health and wellbeing whilst she has been chair of GPC England.  These issues are of great importance to the BMA, and we will seek to deal with them as we commence our new role.’

A BMA spokesperson said: ‘There are also wider concerns about conduct and culture related to GPC England specifically, which the BMA recognises and is seeking to tackle. This includes repeated instances of poor conduct on the GPC England list server and several instances of confidential material being leaked to the media.

‘However, it would be wrong to characterise these issues as being common across the BMA which is functioning effectively and productively, as well as making strong progress in tackling the issues identified in the Romney review. We have an independent external complaints process, as recommended by Orla Tierney in her report and which moved the BMA from the internal conduct and resolution process which was already in existence. The Romney review published in October 2019 was an external facing review into allegations of sexism and sexual harassment, the Review specifically commended the BMA for adopting Tierney’s recommendation that complaints needed to be externally investigated. Daphne Romney also emphasised that staff/members should not feel deterred from complaining on matters and any complaint would then be investigated impartially by a body external to the BMA.

‘GPC England is supported by five dedicated members of staff –  It is also supported by additional staff from departments across the BMA such as policy, public affairs, communications and legal services. However, staff have faced unprecedented levels of work and demand on their time over the past two years because of the essential role of primary care practitioners during the pandemic and then supporting a change to the GPC England leadership to continue to meet this crisis. There have been instances, where due to staffing changes, the level of support for GPC England has been temporarily reduced and this has led to increased demand on those remaining, though they have still provided exemplary support to the committee.’

Pulse: The investigation into leaks from GPC was described as a ‘pointless witch hunt’ and nothing has happened from it

Incoming BMA joint Chief Executive Officers, Rachel Podolak and Neeta Major said: ‘In November 2021, The BMA commissioned an independent review, conducted by Fox & Partners, into the leaks that occurred from GPC England in autumn 2021. This investigation was supported by a Motion to GPC England, also in November, which “deplored the behaviour demonstrated by a colleague or colleagues in leaking confidential committee communications”. The Motion received overwhelming support.    

‘Once complete, the Fox and partners’ findings and recommendations will be considered at a BMA Board meeting before an action plan can be announced and implemented. We look forward to receiving and acting on the recommendations of the report.’

[Pulse note: the motion was passed after GPC members had already received a letter from BMA officials informing them of the investigation]

Sessional GPs feel they are not supported – there was ‘a lack of fireworks’ around the committee’s gender pay gap report from the BMA, meaning it was low down on the list of priorities; there is no appetite to ensure that salaried GPs get the DDRB (Doctors and Dentists Remuneration Board) uplift from practices; and attempts to promote the salaried model contract are not getting off the ground.

There is an ongoing debate within the BMA’s democratic structures about how the representation of sessional GPs may develop in the future. We cannot prejudge the outcome of that debate and process, but the BMA continues to ensure it works hard to support sessional GPs.

We have supported sessional GPs across a number of areas in recent months. These include:

  • Challenging the Doctors and Dentists Review Body on the pay range for salaried GPs, which despite being published annually, is well and truly past its use-by-date. Augmenting our work with the DDRB, we have recently concluded a preliminary piece of work to publicly demonstrate the misalignment between the DDRB pay range and the market rates for sessional GPs. 
  • We have now published an illustrative pay range for salaried GPs in England, demonstrating the misalignment and making the case to salaried GPs and their employers that the DDRB range should not be relied on.
  • We have recently updated our guidance on competition law and locum GPs.
  • In April we published new guidance for GPs working in non-traditional roles as part of a growing toolkit. You can view these here
  • A research project is underway to build a more robust evidence base for pay across the four nations, which will in turn be used to inform our submission to the DDRB in the 2023/24 round as well as guidance for members.

The Ijeoma Omambala QC report found that:

  • Seats on the committee are uncontested and members ‘represent themselves’
  • The committee does not reflect the make-up of the profession
  • Executive is too secretive
  • There is rude bullying behaviour on the listserver that ‘marginalised women and ethnic minorities.

Dr Phil White, BMA GPC chair, said: ‘We take extremely seriously any allegations of bullying or reports of bad behaviour and have an independent process in place to investigate such occurrences. In recent years we have made great strides in representation, and made considerable progress since the 2019 Romney Review, including the introduction of training for members and staff and activities to improve culture. Across the BMA we have increased the representation of ethnic minorities, women and other groups but still have more to do.

‘GPC and the wider BMA is constantly seeking to learn and improve and regularly reviews how it is working. This report will be a valuable contribution to that process. We will need time to digest its contents, but we take seriously the claims made and are committed to working alongside GPDF (GP Defence Fund) to address the issues raised and discuss the ideas proposed.

‘GPC is dedicated to representing, defending, and advocating for all GPs, whatever their background, both through its work as a committee and through the BMA’s wider function as a professional association. As the trade union for doctors, we negotiate with health services and governments across the UK and strive to secure the best deal for all GPs, not just BMA members.’

In addition to action that the BMA is taking GPC England is working on a widespread engagement exercise with the profession on the future of General Practice to enhance engagement beyond the committee. There will always be the need to balance the right of committee members to be fully engaged with process and the work of the committee with the need for confidentiality when in negotiations to avoid anything that risks undermining negotiating positions.

Regarding seats on GPC England committee being uncontested during the election process, the BMA acknowledges there is work to be done to encourage and support a wider cohort of candidates to stand for election for the available seats than do at present. This is a piece of work we will be taking forward in due course 

Several people have told us that there has been little movement on the Romney Report. Many of the people responsible for implementing the Romney report would need to relinquish duties under its recommendations, such as limits on longevity on committees and number of committees they sit on. The Romney report praised the fact ARM (Annual Representative Meeting) had three female chairs, but since then, one of those three left due to sexism.

A BMA spokesperson said: ‘We are not aware of any former female chair of the Representative Body leaving the BMA due to being subjected to sexism or sexist behaviours. The most recent former Representative Body chair gave a statement making clear that she was leaving the BMA for personal and family reasons. She did not cite sexism. Neither the BMA nor our independent external complaints process has been asked to investigate any such allegation from the former chair and the BMA refutes that the reasons for a former chai  leaving were due to sexism.’

The women’s group has not been supported by the BMA, and they deliberately communicate on WhatsApp because they are concerned about using the official ListServer.

The following Romney recommendations have not been implemented/not worked:

  • Ensuring diversity on committees (recent Council elections, GPC make-up)
  • Women’s group – dissatisfaction from the members
  • Quotas on committees
  • Limitation on length of time spent on a committee
  • Limit on number of committees doctors can sit on
  • Multi-member constituencies

We will include comments you want to send us about the Romney recommendations you have implemented. So far, we believe the following have been implemented:

  • Staff have been empowered
  • Two seats for those who have not been elected, on some committees
  • People called out for rudeness to staff on List Servers
  • Panel of doctors widened for resolution process

Standardised Standing Orders are being adopted by BMA committees that for the first time introduce term limits for Chairs. We are now committed to a fundamental review of the impact of introducing term limits on committees and whether and how that could be implemented is being considered at a future BMA Organisation Committee meeting.

It is proposed that as part of communications around BMA elections, members should be encouraged to be mindful of their own capacity when standing for election to committees and to not hold multiple seats to allow others to contribute. Clear information around role profiles and expected time commitments will also be included in communications to emphasise this.

We are also considering updating the Association’s relevant Standing Orders to include a limit to the number of committees that an individual can be elected to from within a committee or constituency. 

A BMA spokesperson said: ‘It is wrong to say that little progress has been made in implementing the Romney report recommendations. In fact, the BMA has made very significant progress in tackling these issues and we are very pleased to be able to say that since the Romney report was published the representation of women has increased right across the BMA’s committees, including into positions of leadership. The BMA now also has its first female ethnic minority chair of the representative body, its first female chair of GPCE (GPC England), who is also from an ethnic minority background. The BMA has also recently appointed two female co-CEOs and a female chair of its prestigious ethics committee and of the International committee and the Patient Liaison Group.

‘In other committees, over the past two years two female chairs of medical students committee have been appointed, a female chair of the Public Health Medicine Committee was elected and throughout this time there has been a female chair of the junior doctors committee, there are many other examples. We also have a female President Prof Neena Modi, immediate past chair of the Medical Womens’ Federation.  Since the allegations emerged that led to the Romney report the BMA has also appointed its first female chief technology officer and both the appointed non-executive directors on the Board are women. In addition, the recent council election has significantly increased the representation of ethnic minority doctors, including female ethnic minority doctors, and has seen the percentage of seats held by men fall below 60% for the first time.’

‘We continue to work hard to improve our culture. Recently a letter sent was to all committees to remind members of the standards of behaviour expected when engaged BMA activities. We have also introduced a listserver warning system.

‘In recent years we have made strides in addressing under representation on committees and made considerable progress since the 2019 Romney Review. An update on the actions taken can be found on the BMA website where you will find a report by Elisa Nardi, NED who chairs the culture and inclusion oversight group (CIOG) which was set up to oversee the implementation of the Romney recommendations. Changes have included the introduction of training for members and staff and activities to improve culture such as active bystander training for both members and staff. Across the BMA we have increased the representation of ethnic minorities, women and other groups but recognise that we still have more to do’

Incoming BMA joint Chief Executive Officers, Rachel Podolak and Neeta Major said: ‘As the incoming joint Chief Executive Officers, we want to build on the range of work that has already been undertaken to implement the Romney recommendations as well as the BMA’s own initiatives to improve the culture of the BMA. As the pandemic recedes, we can shift some of our focus away from Covid-19 and improving our culture will be a priority for us. We know there are still challenges and areas where improvement is required. We want to move forward quickly, making sure we keep members and staff engaged and fully informed of our plans.’

The pandemic impacted on committees’ capacity to focus on interpreting what the recommendations mean in practical terms and assessing any unintended consequences.  Standardised standing orders, which were developed by and will be maintained by the organisation committee, have now been adopted by most BMA committees. They provide a framework for introducing a consistent and systematic approach to implementing the recommendations related to committee structures which previously did not exist and will assist with developing clear timescales and an action plan for implementation.

Following a pilot programme over the 2020-21 session, the BMA committee equality champions programme has been approved by BMA organisation committee to run permanently. The BMA committee equality champion is a standardised role across BMA committees. The remit of the committee equality champion is to:

  • Act as a point of contact and advocacy for branch of practice-specific or pan-BMA equality issues.
  • Ensure that equality considerations are fed into all discussions and items on branch of practice committees.
  • Champion the BMA’s commitment to equality, diversity and inclusion.

Tierney found that complaints ‘were raised to stifle debate, disrupt elections and to settle old scores’. There have been at least half a dozen lawyer-led investigations of GPC England members in the 2021/22 session, at great expense to BMA members.  

Incoming BMA joint chief executive officers, Rachel Podolak and Neeta Major said: ‘In July 2019 all the Tierney report recommendations were shared with the BMA’s council. The current external independent complaints procedure is the product of those recommendations and that report, and this approach was endorsed by the Romney review. The use of an independent law firm, Weightmans, was specifically recommended by Tierney.

The Tierney report was also clear that all complaints required investigation which is why if there are a higher number of complaints on a committee, it would follow that there is a higher number of investigations.’