Bob Baker: The British Medical Association: the worst of all worlds

'It is a desperate drive for consensus that represents to me the failure of the BMA'

If you have to see a doctor this week and you catch them yawning, there's a very good reason. The British Medical Association conference season is upon us once again. The BMA is the doctors' trade union, and is meant to represent our interests to our employers. Most doctors welcome the conference with a fanfare of indifference. Unless, of course, their own interests are directly threatened.

The reasons for that apathy are multiple. First, doctors like to think of themselves as busy, practical people doing good for others for whom politics is a tedious and self-interested diversion from the task in hand. Next, the kinds of people who become involved in medical politics do not always inspire our wide-eyed admiration. Razor-sharp trouser creases and earnest spectacles are the conventional uniform, usually donned about age 15. Next, doctors – in Britain particularly – fancy themselves as individualists and often builders of empires. Managing them, in one famous phrase, is like herding cats. Not an easy group to lead.

But there is something peculiar about the BMA conference that brings out Olympian inertia in the profession. It is probably a feature of all modern politics, and that can be summed up in one word – consensus. Representing a profession as varied and contradictory as ours means that you cannot, as a senior medical politician, speak out radically. You have to achieve the support of your constituency and anything controversial would threaten that.

And it is that desperate drive for consensus that represents both the success and (to me) the failure of the present BMA and its president, Ian Bogle. He appears to have achieved consensus. But he has done it in a peculiarly Blairite, nugatory fashion.

Mr Bogle says nothing that we could disagree with – "Governments must make workforce and frontline investment their priorities", for example. But nothing you would raise a revolutionary flag for either. More money, less bureaucracy. Motherhood and apple pie. It is left to jaunty radicals like the ex-NHS Trust chairman Roy Lilley to suggest more cranky solutions like closing all GPs surgeries. We probably do need a revolution of some sort.

So the BMA's president may have a fantastically brilliant plan for resolving the various conflicts and issues that fissure the NHS. But he can't tell us precisely what it is, because we might disagree with it. His position is rather like the Government's on the euro. They know what they want but if they put it on the table the voters may reject it. Their best hope is to stealthily shift public opinion in a way that we hardly notice, until we all wonder why we ever thought any other way. Mr Bogle has to claim to represent us in discussions with the Secretary of State for Health Alan Milburn. He needs us to ignore our differences to give him authority.

So what are those differences? The BMA has to represent three principal groups. Those are GPs, hospital consultants and doctors in training. Each has their own agenda, their own problems and their own grievances, and these may conflict.

Let us take just one example. The Government has been committed for some time to reducing the number of duty hours of junior doctors. This is problematic. Reducing the hours without increasing the number of doctors is an insoluble equation. Some are also concerned that juniors may be getting insufficient training to look after patients safely out of hours.

One – possibly the only – answer, which I don't see getting much air time, is for consultants to be resident in hospitals during the night. Let me assure you that being resident is not a pleasant proposition in most NHS hospitals. I can well remember as a naïve medical student about to be on duty for the first time saying to the consultant "See you tonight". He blanched, muttered "I hope not!" and scurried out to the car park. I foresee a cat fight over this issue.

And it is cat fights that the BMA fears most. A colleague of mine had to ring the BMA recently to discuss the awkward issue of intimidation within his workplace. He felt that he was being bullied and intimidated. Standard trades union stuff, you might think, and grist to their mill. He explained his situation to his local BMA representative. It slowly dawned that she had absolutely no interest in helping him. The reason? This was a dispute between doctors. The BMA doesn't do those kinds of disputes. Which is a bit like Relate deciding not to do marriages.

I feel avoiding controversy is a terrible mistake. I would advocate more radical internal debate. Who was taken in by the recent public love-in between Alan Milburn, the BMA and the royal colleges, all promising to be nice, consult each other and not be beastly? These are the gestures of show-consensus. The press release reminded me of Richard Gere and Cindy Crawford's declaration that there was no serious difficulty in their marriage. And look what happened to them.

robert.baker@ucl.ac.uk

The author is a practising doctor