Why the BMA is failing to get a better deal for doctors and how they could do it better

Junior doctors have been striking on and off since July 2023 with still no resolution to their pay issue in sight. The BMA is quick to blame the Government but I think the BMA has a poor strategy. The BMA has not learned the lessons of 2009 and seems to be unable to change their strategy to achieve a different outcome.

The current BMA strategy is to demand a large amount of money, 35%, and strike until they get it with progressively longer and longer strikes. This large figure is based on a calculation of a drop in real pay since 2008. Another part of their strategy is to campaign against Physician Associates in what can best be described as a fear-based, bullying campaign. This strategy is wrong for several reasons: First, you are never going to get 35%. The Government is dealing with negotiations from multiple groups, all are getting around 10%, if they give one group 35%, then all the others are going to kick off. Better to settle for something achievable and then keep on top of the annual negotiations going forward. Remember: that 35% real pay drop is the result of the BMA’s poor performance as a negotiator; Doctors need to demand better from their union.

Secondly campaigning against PAs is another poor strategy. PAs are a tiny sector of the medical workforce, PAs work alongside and support Doctors, PAs work closer with doctors than anyone else. PAs are pro—Doctor. PAs are NOT any kind of threat to Doctors. PAs enhance the learning for doctors, reduce the medico-legal liability of Doctors, improve patient safety and improve continuity. Attacking the one group that is most supportive of Doctors is not going to help Doctors – that is what the BMA is doing. A better strategy would be to embrace and work with. Co-operative team-working generally gets better results than confrontation.

Thirdly the BMA seems to be incapable of evolving and adapting strategy. The doctors strikes of 2009 were a disaster. Lots of doctors went on strike and lost pay. The BMA’s strike objectives were not achieved, the BMA lost members (and income) and lots of UK doctors went to Australia. Churning out the same strategy this time, expecting a different result, is unrealistic.

Currently the BMA complains that the government is not talking to them. That is because the Government does not need to. Lots of regularly striking doctors just adds to the argument for privatisation.

So what does the BMA need to do to get a better deal for UK Doctors:

1. There needs to be a complete rethink of the career pathway and management of UK doctors. There are multiple problems: the system is insensitive – I know a doctor training in Bristol engaged to be married to a doctor in Edinburgh because they are both unable to get jobs in the same town. There are not enough specialty training posts. When doctors are on rotations the academic learning they receive is typically poor. The whole system is competitive. There is very little in the way of career guidance and development – you can become a Consultant at 35 – do you really want to spend the next 30 years doing that one specialty? (Difficult to change track when you are earning £120k pa.)

What needs to happen is a working group needs to sit down and work out a career management pathway/model that meets the needs of today’s doctors and the health service. I personally would start but researching globally and taking the best of all the other healthcare systems. Medicine is a great job being blighted, in the UK, by poor career management. This process of looking at the career management of Doctors is not happening because it involves a lot of difficult and complex work. More pay does not solve the fundamental problem – it is simply compensation for misery and it just kicks the problem down the street. The BMA should be taking the lead with this.

Then, once you have renegotiated the career management of doctors, you are in a much better position to work out pay.

2. Consider developing a payscale system, like Agenda for Change. Doctors are the only employees in the NHS who are not on the Agenda for Change (AfC) payscale and they are starting to lose out. Doctors typically have a lower base salary and then get much better enhanced pay for nights and weekend work that is meant to more than compensate. Historically Doctors have held onto a different pay system as it suits them better. But I am not sure it is really working well. Compare an Advanced Clinical Practitioner (an ACP is a healthcare practitioner, typically a nurse with on-the-job medical training) on AfC scale 8a they earn £51-58k a year, they work clinically four days a week and have one day for study and admin. A Specialty Registrar will earn about the same (possibly even a bit less) but have much less time for study/admin and be expected to work nights and weekends. If you develop a payscale system like this it allows you to negotiate using equivalence.

3. The BMA needs to start working closely with other unions. Look at the numbers; BMA 160k members, Unison 1.3mn, Unite 1.2mn, RCN 0.5mn. In a collective bargaining situation, might matters.

4. The BMA needs to get professional help. The big health service unions are much better at their work because they have professional trade unionists. The BMA is fundamentally run by doctors. Doctors are good at medicine.

5. If you are going to strike you need to work out a better strike strategy. Going for longer and longer strikes simply hurts Doctors’ pay packets. I worked out that during the nurses’ strikes of 2023, nurses took a hit of around 5%, Doctors, on the other hand, during the same period of strikes, took a hit of around 17%. The nurses were doing one and two day strikes. It is the same hassle for an employer to organise for a one day strike as it is to organise for a six day strike. What happens on a six day strike is that everyone just gets used to not having you around.

In summary: The BMA needs to start taking a close look at the management of Doctors’ careers. They would give their members a much better service if they did. The UK can and should be the best place in the world for Doctors to train and work. The BMA needs to take a more professional approach to their negotiation to get positive results for its members. And stop knocking Physician Associates, it’s our job to work alongside and support Doctors – we are here to help you.