British Medical Association

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Introduction

The British Medical Association (BMA) is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, this responsibility lies with the General Medical Council (GMC). The association’s headquarters are located in BMA House, Tavistock Square, central London. Additionally the Association has national offices in Cardiff, Belfast and Edinburgh, a European office in Brussels and a number of offices in the English regions. The BMA has a range of representative and scientific committees and is recognised by NHS Employers as sole contract negotiators for doctors. The aim for the BMA is “to promote the medical and allied sciences, and to maintain the honour and interests of the medical profession”^[1]

History

The BMA, founded in 1832 by Charles Hastings, was originally known as the Provincial Medical and Surgical Association (PMSA), the first meeting of which was held in the boardroom of the Worcester Infirmary on 19th July 1832. The Association was established to provide a “friendly and scientific” forum for the sharing of knowledge between doctors. Ten years after its’ initial meeting the Association’s membership had grown to 1350 and it had begun to publish a weekly journal, The Provincial Medical and Surgical Journal, known from 1857 as the British Medical Journal or BMJ.

The Association’s membership grew rapidly and in 1853 the Provincial Medical and Surgical Association extended its membership to London doctors and became the British Medical Association in 1856. Medical students were admitted from the late 1970s onwards.

Although not initially formed with the aim of initiating medical reform, the BMA played a key role in the drafting and passing of the 1858 Medical Act, which established the General Medical Council and set a standard for qualified and unqualified doctors and established a system of professional regulation. Prior to this anyone, qualified or not, could practice as a doctor. This also positioned the BMA to play a major role in future medical politics, campaigning on issues such as Poor Law Medicine, quackery, public health, alternative and military medicine and contract practice. During this time one of the most active and influential of the Association’s bodies was the Parliamentary Bills Committee, formed in 1863 to take a leading role in influencing legislation on public health matters.

The BMA in the early 20th Century

In May 1911 the Government introduced the National Health Insurance Bill which presented the BMA with new challenges. This bill introduced the idea that for a maximum contribution of four pence a week every employed person in the country could be insured against treatment costs for sickness. The BMA supported the principle but had a number of reservations about the scheme including the lack of doctor involvement in delivering the medical benefits, which were instead being delivered by friendly societies and trade unions. In response the BMA produced “Six Cardinal Points” which it felt should be included in any legislation. Ultimately the final bill was passed in 1913 in which four of the six points had been included. This resulted in an income limit of £2 per week being set to join the scheme, there was to be free choice of doctor by patient and the payment to the doctor should be adequate and finally there should be adequate medical representation among the various bodies working on the Act.

With the start of the First World War, the BMA formed a Central Medical War Committee (CMWC), and was given responsibility by the government, for managing the demand for doctors in the armed forces whilst maintaining a full medical service for civilians. The BMA repeated this role during the Second World War. During this time the BMA also campaigned on issues such as the production and marketing of “secret remedies”, nutrition, and physical fitness, the relationship of alcohol to road accidents and the medical aspects of abortion.

Early in the Second World War, the BMA became aware of the need for a change in the provision of medical care to the public after the end of the war and during peace time so shortly after the war, the BMA had produced its’ own plans for a “general medical service for the nation” the plans had a number of revisions incorporating the latest BMA policy on various aspects of health care, and in 1942 the Annual Representatives meeting approved a proposal for a state system “for the whole community” as suggested by the BMA’s Medical Planning Commission. Later in 1942 the Beveridge Report announced acomprehensive national health service was to be established. The White paper “A National Health Service” was published on 17th February 1944.

The BMA and the NHS

Whilst the BMA agreed in principle with the establishment of the NHS, during the initial formation the BMA objected to the administration methods and the lack of consultation and negotiation with Doctors regarding the scheme and the effects that the NHS would have on Doctors lives.

By 1945 a negotiating committee was set up and by 15th December 1945 had announced 7 principles which the proposed service would comply with if it were to be supported by the profession. The seven principles were;

1. No Salaried Service
2. Clinical freedom
3. Free Choice of Doctor for Patients
4. Free Choice for doctors of form and place of work
5. Freedom of every registered practitioner to join the public service
6. A hospital service centred on universities
7. Adequate professional representation on all administrative bodies.

Having gained a number of concessions from the Government, The national Health Services Bill was ready to be published on 20th March 1946 and became law on the 6th November 1946. The BMA conducted a referendum of its members to consider the Act, after 3 votes and a Special Representatives Meeting; the BMA Council recommended that the profession cooperate in the new health service and the NHS came into operation in 5th July 1948. The BMA has continued to play an important role in the NHS, specially in the negotiation of doctor’s terms and conditions. The Association also made a number of significant contributions to high profile government reports during the 1950s and 60s such as The Royal Commission on Marriage and Divorce (1951), and The Wolfenden Committee (1955).

NHS Reform and the Current Role of the BMA

The BMA continued to play an ongoing role in the reform of the NHS by contributing to a number of reports since the founding of the NHS. The Royal Commission on Doctors’ and Dentists’ Remuneration (1956) had important implications for GPs’ pay, and was followed by a second inquiry – The Medical Services Review Committee. The report from this committee, known as the Porritt report was published in 1962 and included important recommendations for reforming NHS administration, particularly for the formation of area health boards. The third committee on General Practice was set up in 1961 under Annis Gillie and was charged with examining the future of General Practice. Its report was published in 1963. Then in 1965 the BMA published its’ General Medical Services Committee paper “A Charter for the Family Doctor Service”.

The BMA continued to actively contribute to public health issues .1971 saw the publication of the BMA's Policy in Relation to Smoking. Whilst in response to the perceived threat of nuclear war in the early 1980s, the Association reported on the possible medical and environmental effects of global conflict. The BMA’s first statement on AIDS was published in 1985 following the world-wide spread of the disease.

n 1989 the Association rejected Kenneth Clarke's so-called reforms of the NHS based on an untried untested and unknown concept of an internal market in a nationalised health service. Led by its chairman Dr John Marks it mounted a powerful public relations campaign involving newspaper advertising, a poster campaign, the issue of 11 million pamphlets for distribution by general practitioners, and radio and television broadcasts in an attempt to educate the public about the dangers of the governments proposals. Even Kenneth Clarke admitted that the Association won the public relations exercise, but predictably the government imposed the internal market.

In 1992, the genetic engineering working party culminated in the publication, “Our Genetic Future”, which considered the scientific and ethical implications of genetic engineering.

By the late 1980s, the BMA continued to negotiate contracts on behalf of doctors, some of them controversial. It has voiced concerns over the impact of European Union directives on the profession; devolution in the UK; new technological sources for medical advice and many other aspects of issues affecting patients and the working lives of doctors.

BMA Policy and the Representative Body

As a democratic organisation, members decide BMA policy through the major policy making body, the Representative Body, which meets annually at the Annual Representatives Meeting (ARM). Membership of this body is approximately 600 and is elected both geographically and by branch of practice. Motions debated at the ARM come largely from BMA divisions (local bodies representing doctors) however they may also come from Branch of Practice or national committees.

BMA Committees

As part of the representative remit of the BMA it has a number of representative committees^[2] formed from members elected at the Annual Representatives Meeting (ARM) and via other election processes, the most senior of these is Council. Council meets five times a year to implement policy as decided at the ARM and to take relevant decisions during the year. Council has 34 voting members, led by the Chairman who is elected by council for an initial term of three years and to a maximum of five.

Reporting into Council, The Board of Professional Activities considers ethical, scientific, research and educational matters whilst The Board of Representative and Political Activities considers reports from the following committees which represent doctors across the seven branches of practice which are;

• General Practitioners Committee (GPC) – representing NHS General Practitioners (GPs)
• Central Consultants and Specialists Committee (CCSC) – representing senior hospital doctors
• Junior Doctors Committee (JDC) – representing junior hospital doctors, including GP registrars in the hospital part of their training
• Central Committee for Public Health Medicine and Community Health (CPHMCH) – representing public and community health doctors
• Medical Academic Staff Committee (MASC) – representing academic and research staff
• Medical Students Committee (MSC) – representing medical students
• Staff and Associate Specialists (SAS) – for doctors in the non consultant career grades.

Branch of Practice committees have a majority of BMA members but may also include non-members, All members are elected. These UK committees are mirrored across the devolved nations of Scotland, Wales and Northern Ireland. The BMA and its committees are recognised by the health departments in national negotiations for NHS doctors and by the Doctors’ and Dentists’ Review Body (DDRB) as representing all doctors within that branch of practice.

The BMA also has a number of committees which represent other specialties and interests which affect its members, these include:

• Medical Ethics
• Board of Medical Education
• Pensions
• Armed Forces
• Civil and Public Services Committee
• International Committee
• Medico-Legal
• Occupational Health

BMA Departments and Staff

In order to execute its’ duties the BMA has approximately 600 staff in BMA House and offices in the UK, led by the BMA Chief Executive /Secretary. These staff are organised into departments reflecting the work of the BMA^[3]

• Membership Development which works to ensure growth of membership (the organisation’s main source of revenue) and that membership benefits and services reflect the needs of the members. Within this department are; Marketing and Publications, Proposition Development and Membership and Professional Records

• Representational and Political Activities works to improve doctors’ lives whether by negotiating a new contract or better pay and pensions for doctors. There are a number of committees each representing the different groups of doctors.

• Professional Activities works to improve the service offered by doctors through the provision of advice, information and support. As part of this they produce research and guidance to support the delivery of high quality health services both in the UK and internationally. These activities are broken down into a number of areas;
  • Ethics – providing advice and guidance to doctors whilst campaigning on human rights and lobbying government departments
  • International – providing advice to doctors from all over the world; both members and non-members members and supporting the work of the International Committee
  • Science and Education is involved in research, policy development, information, and lobbying on public health issues.
  • The Conference Unit organises events of a medical and medico-political nature on behalf of the BMA.
  • The Library which provides access to videos, books and journals to members
  • Doctors for Doctors is a 24 hour counselling line and supports doctors with a range of problems

• Communications works to communicate the activities of the Association with both members, the public and MPs. This is done in a number of ways;
  • Press Office responds to media enquires and publicises the work of the BMA.
  • Public Information Unit deals with enquiries from the public.
  • Parliamentary Unit works to inform and influence politicians’ views on health related issues, promote and defend doctor’s interests in Parliament and increase contact between members and MPs
  • BMA News is the weekly publication sent to all BMA members
  • The Web Team is responsible for maintaining and developing the BMA’s online presence – www.bma.org.uk

Headquarters - BMA House

BMA house has been the headquarters of the BMA since 1925, the Association being originally housed at 429 The Strand, London since its move to London. The building, now grade II listed, was originally designed for the Theosophical Society by Sir Edwin Lutyens with work commencing on 3rd September 1911. However the start of World War One interrupted construction and the Army Pay Office took over the uncompleted building. After the war the Theosophical society could not afford to finish the building, and it was sold to the BMA for £50,000, with the association later purchasing the freehold of the site from the Bedford Estates in 1962.

After purchasing the building, the BMA commissioned Lutyens to complete the building to its specifications. The building was officially opened by King George V and Queen Mary on 13th May 1925. However plans were soon commissioned from Cyril Wontner Smith to extend the building to overlook Tavistock Square. The Association later commissioned Douglas Wood to design two more extensions on either side of Wontner Smith’s front entrance (Build 1938-1950) and one at the back of the building (built 1959-1960).

The BMA's Logo

The logo of the BMA includes a stylised version of the rod and staff of Asclepius, the Greek god of healing. A similar icon, with two snakes and a winged staff, has been adopted as a symbol of medicine by many organisations such as the RAF Medical Service and the Wellcome Trust.

References

1. ^ Bartrip, Peter (2007). "A long way from Worcester". British Medical Journal 335 (pages=72-73).
2. ^ http://www.bma.org.uk/ap.nsf/Content/BMAStructure
3. ^ http://www.bma.org.uk/ap.nsf/content/bmadepartments