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The Weekly paper of the New Communist Party of Britain


BMA – A Venerable Trade Union

by New Worker correspondent

THIS WEEK we take a look at one of Britain’s most successful registered trade unions, although it does not really like to admit it is a union and resolutely refuses to join the Trades Union Congress.

For much of its existence it has denied it was anything so vulgar as a trade union. It only formally became one under Edward Heath’s Industrial Relations Act when a special register of unions was created, basically for it. It has been so successful that some of its members complain they are forced to take early retirement because they are paid so much that they fall into the higher bands on income tax. They are also very highly regarded members of the community, often regarded as heroes or even saints.

Founded in 1832, it presently has 158,405 members, who work in both the public sector and, more controversially, in the private sector. Its listed HQ in Tavistock Square, London is by far the grandest of any union in Britain and makes the nearby HQ of the TUC itself seem mediocre. It even has a proper coat of arms compared with the plebian logos of other unions. For this is the British Medical Association (BMA), which has a duopoly as a trade union negotiator for doctors in the NHS along with the even grander Hospital Consultants and Specialists Association.

Its present membership represents about 70 per cent of Britain’s 240,000 doctors. It once had a rival, the Medical Practitioners’ Union (MPU) founded in 1914, which is now a small section of Unite, but this never had the status or impact of the BMA. The MPU was more openly a trade union and was for a while affiliated to the TUC, but that did not last as small disagreements with TUC policy led them to leave in a huff in the 1930s.

Starting out as the Provincial Medical and Surgical Association (PMSA), the BMA took its present name in 1836 when it started to recruit London members. Its weekly the BMJ (called the British Medical Journal until 2014) is almost equally venerable, starting in 1846, but is hardly your average union weekly it’s just a medical journal. It somehow manages to retain the status of a learned society and a union.

One of its main tasks was enforcing a closed shop for the medical profession. The 1858 Medical Act that it fought for established the General Medical Council, which established a system of professional regulation which made sure that people had to know something about medicine before practicing it – a then revolutionary demand. Some feminists argue this was all a cunning male plot to put midwives out of business; but doing at least something about quacks selling potions that claimed to cure cancer, constipation and rheumatism at the same time was a great step forward.

Positive

It has been said that when a lawyer makes a mistake he adds it to the bill, but that when a doctor makes a mistake he buries it, making regulation of the profession essential. The BMA has played a generally positive role in promoting better public health, supporting measures in favour of sewage schemes, and improvements to military, naval and workhouse medicine, all of which naturally benefited the doctors whose numbers expanded dramatically in the 19th century. But it is very keen that the medical profession keeps firm control of these.

Crumbs

Before the First World War, in the face of the challenge of the rising Labour Party the ruling Liberal Party was forced to offer some crumbs to the working class. One of these took the form of the 1911 National Health Insurance Bill that was an insurance against sickness for employed workers. This was not to the liking of the BMA. It supported the principle but did not like the idea of friendly societies and trade unions administering it rather than their medical betters. As a result, the Bill was deplored by the BMA as “the most gigantic fraud which had ever been perpetrated on the public since the South Sea Bubble”.

The BMA’s president said it was more important to improve public health by ensuring that “the race must be renewed from the mentally and physically fit, and moral and physical degenerates should not be allowed to take any part in adding to it”.

At this time most doctors were opposed to women’s suffrage. But the Bill was finally passed in 1913, with doctors having a greater say in administering it to ensure they got properly paid. Their role in National Insurance brought about a rapid decline in friendly societies, one of the earliest forms of working-class organisation, which doctors always loathed when they had to take orders from them. During the First and Second World Wars it was entrusted with controlling civilian medical services and handling many aspects of military medicine. In the inter-war years, it continued its campaigns against dodgy medicines and foodstuffs, was a pioneer about warning of the dangers of mixing drinking and driving, and took a cautious view about improving access to abortion.

When during the Second World War plans were being laid for a post-war health service the BMA proved very difficult. Although the top level of the BMA had been involved in planning for post-war health services, rank-and-file doctors opposed the final shape of the NHS because it would reduce their independence.

mouths with gold

In May 1948 the BMA voted not to join the new service, but by inauguration day on 5th July they had signed up. As in 1911–13, they exacted a heavy price. “I stuffed their mouths with gold” was how Health Minister Nye Bevan, described how he won them over.

Senior consultants did extremely well and kept their right to continue moonlighting in private practice.

Unions are always there for their members. Often the BMA had a ‘woman problem’. Apart from midwives, in its opposition to quacks it attacked female “healers” and it was not welcoming to pioneering female doctors. Earlier it had mixed views on women. Elizabeth Garrett Anderson was the first woman to join the BMA in 1873 – but the doors were soon slammed shut for another two decades.

Less than two years ago it had to apologise to female doctors after it was described as an “old boys club” that undervalued women after two female members of its GPs’ committee complained about a number of incidents that they said demonstrated a “sexist” culture within the committee. This seems confirmed by the fact that the union has never had a female chair of council or leader in its entire history, and women are under-represented on nearly all BMA committees.

The BMA supports the NHS but vigorously defends its members working in private practice and hospitals, both full-timers and those with NHS contracts. It is sometimes conspicuous by its absence when there are campaigns to prevent the closure of small local hospitals as doctors find it more agreeable to work in big, centralised hospitals, which it argues provides for better services.

On the matter of strike action, the BMA has used it very rarely – but on many occasions it has used the threat of refusing to provide medical services, which is much the same thing, as we can see from its actions in the early days of National Insurance and the NHS. There were overtime bans in the 1970s.

Efficiency

The fact that it is not difficult to distinguish between the cars belonging to doctors and nurses in hospital car parks says much for the BMA’s efficiency as a wage negotiator. The lure of high wages offered by American hospitals, which have a preference for native English speakers, means that NHS bean-counters cannot be too tight fisted even if they wanted to be and that doctors have no need to mount a picket line to get high wages.

Like many unions, it has to balance a number of conflicting interests within its ranks. For instance, calls by junior hospital doctors for a cut in their long hours do not go down well with more senior colleagues who went through these same hardships in their younger days. In the 1970s it lost a lot of younger members over its failure to handle this issue – but it has learnt its lesson, resulting in its present monopoly.

Conversely, much of the BMA’s authority as a medical body depends on having within its ranks senior consultants who make a fine living from private practice.

At present the pandemic has put doctors under unparalleled strain, resulting in the BMA taking the revolutionary action of contemplating industrial action for junior medics who are insulted by being excluded from the three per cent NHS pay rise – having to make do with a pre-pandemic offer of two per cent at a time when they claim their wages have declined by 23 per cent since 2008–9. It remains to be seen if the show of militancy lasts.

To give just one example of how it handles delicate issues, on the question of abortion it is very cautious. The BMA supports the Abortion Act 1967 as “a practical and humane piece of legislation”. It also seeks the decriminalisation “in respect of health professionals administering abortions within the context of their clinical practice” and is in favour of decriminalising women who procure and administer the means of their own abortion. It is does not agree with more radical feminist demands that abortion should be totally unregulated and wants criminal and civil laws that apply to other aspects of clinical care to continue to apply to abortion.

The balance of acting as a trade union and as a professional body is a difficult one, but the BMA seems to manage it.