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.
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. pulsetoday.co.uk/risingtide