I have been a GP for almost 30 years and joined the BMA in 1979 in order to receive the BMJ when I was a medical student. I have never been that interested in medical politics and believed that the BMA would do its best to ensure that doctors are treated fairly. But now I suspect I have been rather naïve in that regard.
To be honest, I found the advice for GPs that the BMA produced for the ‘day of action’ on 21 June embarrassing. It was a gift to the papers, who seem to enjoy doctor-bashing at every opportunity, and I think it lost us as a profession considerable credibility in the eyes of the public. The then-health secretary Andrew Lansley must have been laughing his head off.
For starters, it seemed as if the BMA did not understand primary care and how it works. Many GPs are self-employed, contracting to provide services to the NHS, and in doing so employ a large number of clinical and administrative staff to make their services run as smoothly as possible for their patients.
How would it ever have been possible to cease working for a day in that situation without harming any patients, given the many consultations that occur?
Furthermore the message the BMA was giving to the public seemed unclear. I got their point about the pension renegotiation in 2008, and the fact there should be no further change. But where the message was not clear was the fact that doctors were now being expected to pay more than other senior civil servants for the same pension.
This is an unfair extra ‘tax’ on doctors who are, after all, a soft target because they put patients’ interest ahead of their own in most cases. From talking to friends, it was clear this message had not got through.
It is a pity that nothing more imaginative was discussed with the profession. We were balloted to ask if we would take action and I said ‘yes’ to that. But we were not asked for our opinions on what type of action we wanted. And when it became clear the BMA had opted for something that would harm patients, like many others I went to work squirming slightly. As I drove I listened to the BMA’s chair at the time, Dr Hamish Meldrum, on Radio 4’s Today programme. Even to me, his defence sounded unconvincing.
As predicted, nothing changed as a result – except that, to add to our embarrassment, the BMA is now trying to negotiate with other unions that their members pay more and doctors pay less into the pension. Good luck with that.
Better targets for action
I cannot understand why more obvious targets for industrial action – options that would not have harmed patients, yet would have potentially embarrassed the Government – were not considered. For example, why are we co-operating with paying hundreds of pounds each year for the joy of CQC accreditation, which will serve little purpose other than to tick a box and could significantly disrupt the safe running of practices by diverting scarce resources into completing policies and protocols?
Why as a profession are we co-operating with commissioning and the abolition of PCTs? Let’s face it, it is unlikely we will be able to make the savings QIPP demands because no one is being honest with the public about what the NHS can afford to do. Expectations are inexorably rising and GP commissioners will not be allowed to start on a level playing field with the old PCTs as we are expected to do their work for significantly less money. If or when we fail, it will be our fault. There’s another potential headline for the doctor-bashing newspapers.
As a last resort, the profession could refuse to co-operate with revalidation. There are plenty of other monitors on our performance without this. If no one is revalidated, is it really likely the GMC or the Government will say no patient can go to primary care because their GPs are unlicensed?
After 21 June, I resigned my BMA membership, pending it reconsidering a more sensible approach to the new pension tax against doctors, and more effective communications with members about what we think of the campaign. Hopefully the £400 or so I will save from my membership fees will go a little way to towards offsetting this extra pensions ‘tax’ I must now pay.
Dr Ian King is a GP in Redhill, Surrey