While the BMA squabbles over money and status, the NHS declines and patients suffer
With trade union militants poised to take control of the British Medical Association, we face the unedifying prospect of doctors squabbling over money and status as the NHS teeters from one crisis to the next, writes Wen Wryte.
When the trade union of a caring profession is dominated by greed on behalf of its members at the expense of those it claims to serve, this is not simply an indication of the moral underdevelopment of those who promote this agenda, but also of the weakness of sense of mission of their main employers. This is what is now happening with the British Medical Association, by far the largest trade union of the medical profession.
The current chair of the GP committee of the BMA has suddenly resigned – indicating that he does not agree with the direction the union is moving in. The possibility that the BMA is about to be taken over by militants who regard their primary mission as seeking better pay and conditions for already well-remunerated doctors heralds a decline in the reputation of the profession.
The militants dress up their arguments in the usual rhetoric of providing patients with a better service, but this is a disguise for pursuing selfish interests. The claim is that GPs carry out a lot of activities which are not currently funded as part of their GP contract. Such as taking blood, conducting spirometry tests and inserting pessaries. All GP surgeries offer such services, but in larger practices these are normally carried out by nurses or other clinical practice staff, whilst being paid for by the NHS.
In other words, this amounts to an argument for a 'work-to-rule' by GPs, in pursuit of an agenda for increased pay if GPs are to perform these tasks already paid for by the NHS but usually performed by supplementary staff. GPs are paid to provide a comprehensive service, and their supplementary staff are paid for by the NHS under the practice contract. But the practice remains under an ethical and contractual obligation to deliver that service using whatever resources are available. Which includes the GPs themselves. GPs are independent contractors: their practice has already been paid to provide such services, but the militants want more money for providing care they now consider beneath their status.
The line taken by hard-line union activists at the BMA is unethical, and reduces doctors to the same occupational status as builders. The only aspect of the caring professions which distinguishes them from occupations which have a purely pecuniary motivation is that a caring profession's raison-d'être is to deliver conscientious care, not just a service.
GPs are supposed to be the leaders in their practices, yet if they work-to-rule over pay and status they effectively abandon this leadership role, which is a betrayal of their ethical commitments to their patients.
The power-struggle within the BMA is symptomatic of a much deeper malaise within the NHS. It is now almost completely dysfunctional as an organisation, staggering from crisis to crisis, the result of a number of deep-rooted problems (including massive uncontrolled mission-creep over the years, and its being a political football from the get-go). But what has become evident during COVID is that those leading the medical profession have all but abandoned any meaningful commitment to medical ethics.
The official response to COVID provides a case-study of a profession in intellectual and ethical decline. We were instructed from the beginning of the epidemic not to bother our GP surgery if we fell ill with COVID, and only to call 999 if we were already seriously/critically ill. No early-symptoms treatment was available in the UK, and so no protocol was provided to guide GPs.
Yet the GP practices are termed 'Primary Care Services', and the hospitals 'Secondary Care'. With COVID, GPs suddenly dropped out of the picture entirely, and we were told we should not bother the hospitals because our primary responsibility was to help 'save' the NHS, which at the same time claimed it was there to save us. The flawed logic here is obvious.
Even though the SARS-CoV-2 virus itself has no specific treatment (that is, until very recently when new anti-viral drugs come onto the market), the treatment of early symptoms becomes vital if the development of life-threatening complications is to be prevented in the vulnerable. But no early symptoms treatment was provided (even though the necessary medications are cheap and mass-produced). Effectively, the message to ill people was 'You're on your own, until you're at death's door. Only then might we try to save you.' Patients in the community were abandoned to make life easier for the medical profession.
To term this approach 'unethical' is an understatement. It's arguably criminally negligent, and goes against all the proclaimed ethics of the medical profession and all the standard protocols in both preventative and acute medicine, which is that the earlier any serious and potentially life-threatening condition is treated, the better the outcomes will be statistically. None of these considerations were deemed to apply to COVID.
The impending take-over of the BMA by doctors who believe it is beneath them to perform necessary medical functions when circumstances prevent these being carried out by supplementary staff is a classic case of occupational status-protection (like an old-fashioned demarcation dispute in a car factory). If the supplementary staff are not available and the patient needs that care there and then, the burden of responsibility devolves onto the doctor, who is in a leadership role. That's what the 'caring' in the term 'caring profession' means: you do not stop to check your contract each time you think you may have an excuse to duck out of delivering care which you have been trained to deliver.
Well, we are where we are. The NHS will continue to decline until it is abolished and replaced with a system more responsive to the needs of patients, and the collective standards of the medical profession will likewise continue to decline unless there is a re-awakening of the idea that medicine is a vocation not a route to status, wealth, and power using the methods of a 1970s automotive trade union.
