Has BMA “…marched doctors into a dead end”?

When I was an active medical teacher I used to repeat yearly “It’s not enough to care, you have to show you care”. Any UK Minister of Health needs to understand thus if he wants to settle the dispute with the doctors in the short term….  A joint consensus on the ideology and what is possible for a universal health service might also help in the long run..

Image result for dead end cartoon

 Daniel Finkelstein in The Times 7th September 2016 opines: BMA has marched doctors into a dead end – The medical profession has harmed itself by encouraging hospital staff to take part in a dispute few of us understand

Almost every parent has had it. The awful lurching feeling when you realise that, having lost control of the situation, you’ve threatened a punishment you can’t impose or don’t want to. “Do that again and it’s no television,” for instance, when you have an important work call to make in ten minutes’ time.

What do you do if the threat doesn’t work? How do you choose between the loss of credibility and power that comes from climbing down, and the virtual impossibility of pressing on?

This is what has now happened to the junior doctors. Hard working, capable professionals have been betrayed by an amateurish, erratic union leadership that has lost control of the situation and hasn’t a clue what to do next. The BMA has urged its members to fight the good fight and marched them all straight into a dead end.

When the BMA announced that it was planning a series of five-day strikes there was, rightly, outrage and concern. If they went ahead, people might die. People would certainly suffer. But as well as thinking “how immoral”, another thought occurred to me. How stupid.

If this was an evil scheme, it was of the sort dreamt up by Dick Dastardly in Wacky Races. Approximately two minutes’ thought, possibly less, is all you’d need to realise that the plan wouldn’t work. Either the BMA would have to abandon the strike or it would go ahead and find that many junior doctors reluctantly didn’t join in. Curses! Foiled again. Drat, drat and double drat!

If you run a union, you need to think deeply about the nature of your power. The doctors have, rightly, the political power that comes from being admired and trusted. Their strike power, however, is entirely theoretical. Strikes won’t work if they don’t impact upon patients, and yet most doctors aren’t willing to damage the interests of patients. That, after all, is part of the reason they are admired and trusted.

So by the time they got to the point of actually having strikes, as opposed to talking about them, the union had already lost. How could an intelligent group of people have failed to work this out for themselves?

The first five-day strike has been abandoned — of course it has — using the excuse that it is too soon and they need more time to plan. Before long they will have to abandon the others, unless they want to press on with action that is the worst of both worlds — a political flop that harms sick people.

How did they get themselves into this position? How did they fail to achieve their aims and secure their demands, using only their almost irresistible soft power? The answer to this puzzle is easy. They never had any real aims or demands, so it wasn’t possible to secure them. And this is the single most important thing to understand about the doctors’ dispute.

On the face of it, the whole argument has been about the proposed new contract for junior doctors. It’s not safe, it’s not fair, it will lead to a pay cut, the government won’t negotiate. Yet the more you looked into the row, the harder these complaints were to sustain.

It was obvious that the proposed contract was safer rather than less safe and would not involve pay cuts. There were increases in basic pay that compensated, for example, for changes in pay for weekend working. There were improvements in the way work was spread around the week, in an attempt to reduce fatigue.

If it was ever reasonable to question this, it certainly isn’t now. During the brief period in which the BMA was willing to behave reasonably it quickly reached a deal on a contract that it announced was safe and a good deal for doctors as well as patients. It is this very deal — the one that it agreed to — that it’s now proposing to strike over.

Doctors are, essentially, organising a massive, damaging strike against themselves.

I now challenge anyone to identify a policy that would settle the dispute. It isn’t remotely clear what further specific, concrete changes to the contract the doctors require in order to render it acceptable. If you know a protesting junior doctor, try asking them.

The reason they will not be able to answer is that the dispute has never really been about the contract. It’s simply a loud, angry protest about a very difficult job, which is emotionally taxing and physically wearing and sometimes just seems a bit too much. It’s impossible not to feel a little sympathy and impossible also not to feel a little bewildered about what to do about it.

People try incredibly hard to become medical students because being a doctor is a very good job. If you are a doctor you are in one of Britain’s top ten best paid professions. Since Britain is one of the richest countries in the world, this makes you the holder of one of the best paid jobs in the world.

British doctors are also among the best paid globally and we are one of the most attractive destinations for foreign doctors. Many more doctors come here to work than leave. We now have far more than we used to and they work shorter hours.

It is also ludicrous to suggest — as has often been argued during this dispute — that doctors are undervalued. If you are a medic you are, justifiably, accorded great respect and your work is satisfying and purposeful.

Yet being a doctor can be hard. The feeling of responsibility, that someone’s life is in your hands, can be scary and exhausting. Working nights and weekends is part of the job, as are long hours.

It’s not surprising that it is easy to be roused to anger about change, to be frustrated if you haven’t enough resources, to be furious if there are gaps in the rota because we haven’t trained enough doctors. All these feelings have become attached to the contract when, in fact, they have nothing to do with the contract.

So Jeremy Hunt must now impose the contract because there isn’t anything to be gained by any other course. In fact, he cannot settle the argument over the contract except by simply introducing it.

Listening to doctors, trying to understand the underlying problem, improving training and working conditions, ensuring that the number of doctors keeps pace with the work they are being asked to do, all these are necessary and sensible.

Yet there is nothing to be done on these strikes than to face them down. In truth Mr Hunt would be doing the BMA a favour.

This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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