Junior doctors schedule date to ballot for industrial action
Faith in the system
Why Muslim doctors and medical students can feel marginalised 8-13
Getting a grip of gambling
Gambling disorder is a public health threat and needs better treatment services
In staff we trust
Finding an alternative to GP partnership or salaried service
Pioneer of the profession
Farewell to the GP who took on Margaret Thatcher’s government 18-19
Meet the team
Here to help: the leaders of the BMA introduce themselves 20-21
Dragged into a culture war
Actor Juliet Stevenson portrays a doctor caught up in a media storm
The tools to face the winter crisis 23
On the ground
A consultant receives practical and emotional support from the BMA
Junior doctors in England formally entered a trade dispute this month with the UK Government and took the decision to ballot for industrial action.
Juniors have seen their pay eroded by more than 25% since 2008 and a foundation year 1 makes the equivalent of £15 per hour. As nurses are seeing too, the NHS is losing its trained experts at an alarming and unprecedented rate to retirement, to more attractive terms, conditions, and lifestyles abroad or from medicine altogether. Enough is enough.
No doctor wants to strike – this step is a very last resort – but with many graduating with tens of thousands of pounds of debt, now is the time to act. We have given the Government ample opportunity to engage but, so far, they have refused to meet our representatives, refused to listen and refused to act. I fully support our junior doctor leaders and our members in other branches of practice taking a collective stand.
On the following page of this month’s issue of The Doctor you can find out more about the dispute process – including details of the ballot of junior doctors which is likely to be conducted from around 9 January.
We also look at the growing alarm from the medical profession with gambling. As we find out in this in-depth feature, gambling is often a ‘secret addiction’ carrying a large burden of morbidity and mortality. Regulation is deeply inadequate and, as Henrietta Bowden-Jones, the national clinical adviser for gambling harms, says in the piece, immediate work is needed to improve access to treatment.
We pay tribute to John Marks, BMA council chair from 1984 to 1990, who has sadly passed away at the age of 97. Dr Marks defended the NHS against the Government introduction of the internal market, campaigned to protect the rights granted through the Abortion Act 1967 and led the BMA’s response to the, then, emerging challenge of HIV.
There are a number of other fascinating features in this issue of the magazine including an important article looking at Islamophobia in medicine and the experiences facing Muslim medical students and doctors across the UK. We also feature a GP practice which has introduced a ‘John Lewis style’ of ownership and an interview with Juliet Stevenson, who is playing Ruth Wolff in Robert Icke’s play, The Doctor
Keep in touch with the BMA online at instagram.com/thebma twitter.com/TheBMA
Junior doctors are to ballot for industrial action in early January in England after the Government failed to meet the BMA’s demand for pay restoration to 2008/09 levels by the end of September.
Members of the BMA junior doctors committee voted in favour of the ballot on 1 October as they appointed two new co-chairs.
JDC will request approval from BMA council to ballot junior doctor members in England from about 9 January.
To support doctors who want to take part in industrial action but cannot because of personal hardship, the BMA has created its first-ever strike fund made up of voluntary donations.
Junior doctors have experienced real-terms pay cuts of more than a quarter of their salaries since 2008/09. The Government this year gave junior doctors a 2% pay uplift, excluding them from the higher 4.5% pay uplift for other NHS workers which the BMA says is ‘still derisory’ given the cost-of-living crisis and COVID pandemic.
The pay review body warned Government a failure to include staff on multi-year pay deals in the higher uplift would ‘have a significant effect on motivation, affecting retention, productivity, and ultimately patient care’. Two-thirds of trainee doctors responding to a recent GMC
survey said they ‘always’ or ‘often’ felt worn out at the end of a working day.
The BMA is ‘deeply concerned’ continuing pay erosion will drive doctors out of the profession at a time of record backlogs and when the NHS ‘can least stand to lose them’.
A recent BMA survey showed 83% of junior doctors in England believe the 2% pay award is ‘completely unacceptable’, and 72% would be prepared to take industrial action.
New JDC co-chairs, Robert Laurenson and Vivek Trivedi, said: ‘The Government’s continual failure to value junior doctors and reverse years of pay erosion has left us with no choice but to enter a trade dispute.
‘A junior doctor is not worth more than a quarter less today than they were in 2008. Many of us are struggling to pay our rent, mortgages, childcare costs and energy bills and questioning whether the continued struggle is worth it.
‘The NHS is paying the price for the Government having presided over years of pay erosion with a chronically understaffed workforce. Strike action is always a last resort. No doctor wants to take industrial action, and this is, of course, still wholly avoidable if the Government commits to full pay restoration.’
To contribute to the strike fund, visit bmastrikefund.raisely.com
‘A doctor once asked me, “How can you be an intelligent woman and wear that [hijab] on your head?”’
Khadija Meghrawi is proud of being a medical student and Muslim – it should not be a choice but sometimes she feels as though she is being forced to pick between the two.
‘A doctor once asked me, “How can you be an intelligent woman and wear that on your head?”,’ she says, referring to the hijab. ‘And my case isn’t even the worst I’ve heard. You feel the constant question in the eyes of those around you. Both a medic and a Muslim? Our pride in following Islam is
continuously pitted against our pride in our medical careers.’
Islamophobia is defined as a dislike of or prejudice against Islam or Muslims. Research from Birmingham University published in January this year shows more than a quarter of the British public feel negatively towards Muslims, with almost one in 10 feeling ‘very negative’.
There is little doubt it exists in medicine, too, according to a survey of healthcare workers, including doctors, published in The Huffington Post two years
ago, in association with the BIMA (British Islamic Medical Association). It found 81 per cent had experienced Islamophobia or racism, while 57 per cent felt it had held them back in their NHS career progression. The BMA report Racism in Medicine , published this year, found 30 per cent of respondents thought the racism they experienced was linked to religion and belief, with many citing experience of Islamophobia.
Difficult conversations Salman Waqar, the vice president of the BIMA, wants
Muslim doctors and medical students can feel marginalised and misunderstood. They need allies to help them combat prejudice. Jennifer Trueland reports
to see greater awareness of Islamophobia as well as steps to stop it happening.
‘Religion is one of the nine protected characteristics in [equalities] legislation and it always feels like it is an unprotected protected characteristic,’ he says. ‘You can go into a meeting and talk about gender inequality, about LGBTQI inequalities, about racial inequalities, and people kind of get it. But faith inequality is different – people aren’t too comfortable hearing or talking about that.’
BIMA worked with The
Huffington Post to ‘shift the conversation’, says Dr Waqar. ‘You can have all the reports in the world, but the needle is really sluggish to shift,’ he says. ‘I think collaborating with the media was quite helpful because it did unlock conversations outside the four walls of the [NHS] system, which is as important as engaging with and working within the system. Change has to come from within, but it is also responsive to trends and influences that happen outside.’
The in-depth survey of 133 health workers (including
hospital doctors, GPs, pharmacists and medical students) shows that being ‘visibly Muslim’ –for example wearing a hijab or a beard – increases the risk of experiencing Islamophobia.
Respondents say they are fearful of reporting it for fear of repercussions – with one woman doctor saying you ‘may as well flush your medical degree down the toilet’ if you do.
A lot of Muslims felt the articles were a ‘Me Too’ moment for them, he adds. ‘Having their experiences
‘Religion feels like it is an unprotected protected characteristic’
‘Career events, academic conferences, networking dinners, social activities for doctors – so much of them involve alcohol as a large component’
written in raw and unadulterated detail validated them and made them realise that what they were going through was similar and was not acceptable.’
This included Muslim healthcare workers reporting that they were taunted about whether they were applying to join ISIS, being told if they wore hijabs, they wouldn’t get NHS jobs and being urged to eat bacon. One doctor carrying a lot of bleeps was told he looked ‘like a suicide bomber’.
Two years on, doctors are still experiencing Islamophobia, says Dr Waqar, who is a GP in Berkshire, and very few are prepared to talk about it because of fear of reprisals. There is also the question of intersectionality – where someone has more than one protected characteristic and faces compounded discrimination.
‘We know that women are less likely to get into management posts, that nonwhite people are less likely to get senior posts, and the same is true of people who work part time. So, if you look at our community, if you’re
a Black, immigrant, Muslim woman who is a mother and works part-time, then you’re facing a lot of challenges,’ he says.
Initiatives such as unconscious bias training will not, in themselves, be a solution, he adds. ‘That’s not how we’re going to fix this –it is as if making people aware of their biases is going to be enough. That is where it breaks down.’
Doctors should be able to bring their ‘whole selves’ into work, says Dr Waqar, and they shouldn’t have to hide who they are. Employers should take steps to ensure that workplaces truly are inclusive, giving staff the confidence, for example, to use exception reporting where there are issues.
‘There is no way to sugar coat it – there are bad employers and some bad individuals out there. But I do think most people just aren’t aware of these issues, and don’t realise they are perpetuating stereotypes or being discriminatory to their colleagues or patients.’
Apparently small things
can make a real difference, he says, such as making prayer rooms available, accessible and suitable, with proper washing facilities, and ensuring there is halal food on hospital menus. ‘If you’ve got a new build happening, is it really too difficult to put that in place? Is it too difficult to ask for things like a chaplain to be available for patients and for staff?’
According to the NHS England chaplaincy guidelines, chaplaincy is ‘not affiliated to any one religion or belief system’.
Dr Waqar is hopeful that positive change is possible. ‘It’s unfortunate that we do have to keep banging the drum until the music changes. But I do think that with each movement the tempo does change – but equally, we are a dynamic society, so we can go back as well as forwards. It’s a constant struggle.’
As a fourth-year medical student in Bristol, Ms Meghrawi is part of the future NHS workforce – but already has fears about how welcoming it will be.
WAQAR:
‘Faith inequality is different –people aren’t too comfortable hearing or talking about that’
Countless students have faced discrimination and marginalisation, she says. For example, Muslim students often feel implicitly or explicitly excluded from the drinking culture that is part of medical school in the UK. This means they lose out on social and professional opportunities.
‘Career events, academic conferences, networking dinners, social activities for doctors – so much of them involve alcohol as a large component. As a student you’re learning what becomes clear as a professional –avoiding environments with alcohol means missing out on opportunities and connections. We would rather stay true to ourselves, but again, why is it a choice? Why should that mean missing out?’
The nature of medical education, where you don’t get to choose where you go on placement, or even who you live with, can also be problematic, she says. She cites one instance where a drunk male medical student barged into the bedroom of a female Muslim student when she wasn’t wearing a headscarf.
‘He apologised and she felt she had no choice but to excuse it, laugh it off,’ says Ms Meghrawi. ‘She also felt no choice but to triple check that she had locked herself in every night afterwards. Such experiences would be far easier to handle back at city campus, among a more diverse student body, in the communities of support that you had found for yourself. In the isolation of placement in a hospital far away, we are all left with little choice but to cope.’
Latifa Patel, chair of the BMA representative body, says BMA surveys and webinars have confirmed doctors can be reluctant to share their faith at work.
‘There’s a fear among NHS workers – and doctors in particular – that declaring their faith and talking about it at work might alter people’s perceptions and behaviour towards them. I think this is a great shame. People bring their full selves to the NHS when they come to work, not just the clinical aspects. They bring their personalities, their background, their heritage –
their religion included. So not allowing people to express their faith is not allowing them to express their whole self,’ she says.
The NHS workforce ought to reflect the population it serves, she adds, and it can be helpful to people of faith backgrounds to feel a commonality with their doctors, particularly if they are frightened or unwell.
BMA surveys, including on race, have shown the problem isn’t only those who are actively hostile. ‘It is not just the person who is doing the discriminating, it is those who are listening to it and not being active allies. There is a call to action here – if you hear anyone making Islamophobic comments, or comments against any religion, I urge you to call it out, because it’s not acceptable. We wouldn’t accept it for our patients and we shouldn’t accept it for our colleagues.’
Being an active ally means not putting the onus on the marginalised or discriminated person to correct stigma and ignorance, she adds. ‘It should be all of our responsibility.’
‘Not allowing people to express their faith is not allowing them to express their whole self’
ambling addiction is an awful addiction.
And it harms so many people along the way.’
Dame Clare Gerada, president of the Royal College of GPs, who set up the Primary Care Gambling Service in 2019, adds: ‘As a relatively new kid on the block with gambling, what really surprises me is just how sick these people are.’
There is growing alarm in the medical profession about gambling. This year’s BMA annual representative meeting agreed to recognise the ‘large burden of morbidity and possibly mortality caused by harmful gambling’ and that regulation is ‘inadequate’.
Unlike dependencies on drugs and alcohol, gambling – for Dame Clare – is often ‘a secret addiction’.
‘For the vast majority of people, using scratch cards or playing the lottery, gambling isn’t a problem,’ she says. ‘But where it is a problem, it’s catastrophic.’
‘If I bet, I don’t have a compulsion to bet again to make up my losses. I walk away. Gamblers think if they’ve lost five times they must win the sixth, when their chances are the same. They don’t realise the basic statistics. They get into this abnormal thinking process, a bit like people with alcohol use disorder – who never think they’ve got a problem.
‘It’s comparable to alcohol dependency, but worse. A six-year-old isn’t allowed to buy alcohol, ever. If they’re tall enough, they can put money into a slot machine at a fair and pull the one-eyed bandit.
‘Someone with alcohol dependency becomes fairly obvious, but a gambler tucked away in their bedroom is well-hidden. It’s such a hidden problem – but treatment works.’
Problem gambling is often identified late. Andrew
Molodynski, a consultant psychiatrist in Oxford and national mental health lead for the BMA consultants committee, says: ‘People tend to present for services because they’re having a crisis and it suddenly becomes apparent. They try and manage it for years, using credit cards or loans and all of a sudden it all falls apart.’
It affects families too. ‘I saw a woman who presented because she was depressed because her husband had a £60,000 gambling debt, which was causing difficulties,’ he adds.
Stigma, and a lack of understanding, remain barriers to treatment.
Henrietta Bowden-Jones, who set up the first NHS clinic for gambling disorders in 2008 and is now national clinical adviser for gambling harms, has been advising NHS England on the rollout of the specialist clinics as part of the NHS Long Term Plan. She says: ‘Only 5% of people who need treatment are coming forward seeking help. It could be that people don’t know treatment exists, don’t feel ready, don’t want to give up their addiction or feel ashamed. A lot of work needs to go into that.’
As director of the National Centre for Behavioural Addictions UK, which includes the National Problem Gambling Clinic, Professor Bowden-Jones sits as the expert psychiatrist with a group of experts reshaping the National Institute for Health and Care Excellence guidelines for treating gambling-related harm and is the co-author of a recently published textbook on how to treat gambling disorders.
Following decades of research and fine-tuning methodology, the service is expanding as part of the 2019 NHS Long Term Plan. New clinics have opened
Gambling addiction is a public health menace and needs to be taken as seriously as drugs and alcohol –but regulation is weak and treatment services often lacking. Ben Ireland reports
‘G
‘People tend to present for services because they’re having a crisis and it suddenly becomes apparent’
in Southampton and Stoke-on-Trent in addition to London, Leeds, Manchester, Sunderland and a national children and young person’s pilot clinic. It is hoped these will offer nationwide coverage, but there are varying statistics on the number of patients who need treatment.
Between April and December 2021, 668 people with the most severe gambling issues were referred to NHS gambling clinics – up 16.2% from 575 during the same period in 2020.
A 2020 YouGov prevalence study estimated up to 2.7% of adults in Great Britain, or nearly 1.4 million people, were problem gamblers – but the Government’s Gambling Commission survey put the rate at 0.2%. The latest Public Health England report on gambling suggests 0.5% of the population (about 246,000) are problem gamblers, and 3.8% (2.2 million) are ‘at-risk’ gamblers.
Professor Bowden-Jones believes immediate work is needed for higher numbers of people suffering from gambling disorder to access treatment: she hopes the service can treat 10% ‘as quickly as possible’.
That would require trebling the 10,000 to 12,000 treatment episodes taking place each year across the NHS and charitable sector. GambleAware says 90% of treatment is accessed outside the NHS.
Dr Molodynski wants an NHS gambling clinic in every integrated care board area. He says: ‘The charities do great work but passing it on feels like it downgrades the seriousness of the problem. Charities are usually run by people who have had gambling disorder themselves. They are very important, but we shouldn’t rely on them. We need sufficient core services.’
Professor Bowden-Jones agrees charities have ‘an enormous amount of people who really care about gamblers and who are really committed’. But she stresses the importance of the evidence-based approach of NHS treatment she has designed including via ‘a national helpline that works’.
‘At the moment, it hands people to the non-state sector. There will be a lot of risk there, we need to make sure people get sent to the NHS when they are severe enough.’
The NHS treatment Professor Bowden-Jones has built is ‘all to do with limiting access to gambling opportunities and shaping behaviour’ using core principles of CBT (cognitive behavioural therapy).
Patients are given a full psychiatric assessment for
comorbidities, other addictions and an overall health check and an early stimulus control programme is created. This includes self-excluding from websites and high street bookmakers, limiting access to gamblingrelated content on phones and laptops and blocking gamblingrelated purchases via banks. Some patients share account details with partners or limit cash withdrawals to £20. One-to-one modules follow if patients have comorbid severe mental illness, or deep trauma –otherwise they go into group CBT.
While Professor Bowden-Jones admits ‘there are always loopholes’, she insists self-regulation works. ‘If you really want to gamble you will find a way,’ she says. ‘But the majority of our patients are stopped from gambling – or it becomes very hard to circumnavigate. I’ve had people throw their laptops to the floor because they’re so frustrated. If there was an invisible barrier in every pub, and you couldn’t use your card to buy vodka in the shop, you’d have quite a bit of trouble drinking.’
Online treatment has helped increase the number of patients the clinics see. The number of did-notattends reduced from 20% to 12% since the pandemic forced treatment to go virtual. Professor BowdenJones points out: ‘Gamblers have used travel money to gamble. Our patients often have more than one
‘The charities do great work but passing it on feels like it downgrades the seriousness of the problem’
Greater access to services needed
job to pay debts – and they all have debts – and many are under close scrutiny from families who don’t want them to disappear for the day.’
Professor Bowden-Jones says 70 to 75% of people ‘do very well’ in treatment, which means they are not gambling at all. ‘The only way forward with gambling is abstinence,’ she adds. ‘There is no way someone with a gambling disorder can return to a healthy relationship with gambling. They will always relapse.’
She says 20 to 25% return but notes they could be being treated elsewhere, which isn’t yet measured routinely.
Dame Clare’s primary care service uses a patient-determined outcome measure called Cyclops, developed for mental health. ‘Abstinence is an important measure of success but it’s such a hard measure and there are others,’ she says, explaining how patients mark progress by reducing gambling, keeping money aside to buy presents for children or managing co-morbidities such as drug or alcohol use. Though she stresses: ‘You can’t just gamble a bit. You either stop gambling or you don’t.’ And because of the frequency of comorbidities, ‘you might get smoking going up if there is an
improvement in gambling’.
Sam Chamberlain, professor of psychiatry at the University of Southampton, and consultant psychiatrist at Southern Health NHS Foundation Trust, is service director for the new Southern Gambling Clinic. He has led on clinical trials for new gambling disorder treatments, authored clinical books, published research about gambling and related disorders and leads a specialised NHS clinical service for other behavioural addictions and obsessivecompulsive related disorders. He says: ‘I’ve been waiting my whole career for appropriate funding to be made available for gambling treatment in the NHS. We thought it would never happen.’
His service also uses CBT, but he says the use of evidence-based medications ‘can make a real difference’ with certain patients and this is ‘tailored to the individual’.
‘Some people might not respond to a particular treatment, or they might not be available in that area, or they might have a strong preference for a different type of treatment,’ he says, noting different clinics try different evidence-based approaches and share results with each other.
‘There’s a lot we still don’t understand about gambling disorder, especially in the UK,’ says Professor Chamberlain, who explains the importance of continued research alongside treatment. ‘We have evidence-based treatments but we need larger clinical trials for CBT and medications in order to firm up treatment guidelines. There are exciting opportunities to develop new treatments and early interventions based on comprehensive biopsychosocial understanding of the condition, informed by the latest findings from the neurosciences and psychology.’
He works proactively with charities assisting people with debt, and homelessness shelters. ‘But that’s different to working with charities directly funded by the gambling industry,’ he explains, but adds: ‘That doesn’t mean I don’t think there’s a role for other services as well. People should have choices.’
Professor Chamberlain says: ‘Gambling disorder has probably existed since mankind began. We have records of people gambling excessively in ancient texts. But it was only relatively recently, in the 1980s, when it first became more widely recognised as a mental health condition. There’s always been a need for treatment but there’s been an under-recognition and a lack of drive to develop clinical services.’
‘What we’re seeing now, with the internet and apps, is people increasingly not only physically gambling in a
‘I’ve been waiting my whole career for appropriate funding to be made available for gambling treatment in the NHS’
Gambling disorder can lead to criminality and homelessness
casino or the bookies, but on their phones, which they have 24/7. And it can be highly addictive.’
Professor Chamberlain explains how gambling disorder leads to other negative consequences, such as homelessness, anxiety, depression, substance misuse and criminality. ‘If we give evidence-based treatments to reduce gambling disorder, we can reduce those wider harms as well.’
Dame Clare says of the 150 to 180 patients who have been treated at the Primary Care Gambling Service, ‘only about five haven’t had co-morbidity’ reporting schizophrenia, bipolar, alcohol and drug dependency and homelessness being linked.
‘It shows the system is preying on the vulnerable,’ she says. ‘Gambling is one part of a complex system of problems that’s either caused by gambling or the gambling is coincidental. We need to start to unpick this.’
She believes the NHS needs to make it ‘as easy as possible’ for those with gambling disorders to seek help and wants to raise more awareness of early signs of addiction, such as chasing losses, feeling guilty, secrecy and people spending more time or money than they can afford on gambling.
Dame Clare used her experience of working in a shared care service treating people with drug addictions to plan the intermediate, multi-disciplinary, GP-led service she runs for gambling now.
‘We sit between the third sector and the specialist
sector,’ she says as she explains the service is there to take the weight off GPs who ‘are worked enough’.
The service asks only for minimal details from GPs, accepts self-referrals and treats patients who want to remain anonymous. ‘The role of the GP is to identify and refer and try and support affected others. It’s too much to ask a GP to manage this complexity.’
Dame Clare says gambling is hard to spot because it’s ‘in the background’ – but urges GPs to add gambling questions to basic screening. ‘If you ask about smoking and alcohol, ask about gambling too,’ she says.
‘Ask simple questions, like “have you ever felt guilty about the amount of money or time you’ve spent on betting?” Ask about it in depression, domestic violence and debt. If somebody has attempted suicide, especially as a man, ask about gambling.’
One aspect of the ARM motion is to allow coroners to cite gambling as a factor in suicides.
Dame Clare agrees. ‘If you’re a smoker, and you die of a smoking-related disease, a coroner can put that down. There are serious amounts of completed suicide in which gambling is a cause, yet we don’t put gambling down. Until we do, it will remain hidden.’
Dr Molodynski believes coroners would be supportive of the change. ‘If they record when suicide is a factor, it can be measured and monitored to help show the scale of the problem as well as put pressure on the gambling companies to do more.’
‘If you ask about smoking and alcohol, ask about gambling too’
And putting pressure on gambling companies to do, and contribute, more is high on the agenda for Professor Bowden-Jones. She has been calling for a levy of 1% of GGY (gross gambling yield), essentially profits, rather than voluntary donations from the sector – which made £14.1bn in 2019/20. This has the backing of the Lords gambling industry committee but has not progressed through the Commons. There are reports it is low on the new prime minister’s list of priorities.
Professor Bowden-Jones argues: ‘You need independent funding to make sure the right questions are being asked and a levy wouldn’t cost the Government anything. Research is very expensive, and the bodies funded voluntarily are never going to commission research that is exact. I’ve been calling for a large-scale prevalence survey in this country for 15 years, it’s one of the many issues, such as randomised control trials, that have not been studied enough in this field.’
Until such independent studies happen, policymakers will have ‘no idea’ if the problem is growing, she adds.
And she is adamant regulation isn’t strong enough, partly because the ‘nanny state’ argument is very strong at the moment owing to a lack of research.
‘What I’m told all the time by politicians is, “yes, but the country has a right to gamble” because gambling is not illegal in the same way as drinking is not illegal.
‘Whenever we talk about banning advertising you’ll find politicians, or the general public, saying we’re too extreme – and that gambling only harms a small minority. We don’t know what minority because we haven’t invested in a prevalence survey that works.
GERADA:
‘There should be much more responsibility on the gambling industry’
cigarette packaging, giving the stats for the number of people who end up in debt or committing suicide. At the moment it’s all positive advertising. It’s all over sports such as football, like when there were cigarette adverts in Formula One.’
Dame Clare agrees. She believes the libertarian argument against that ‘puts the responsibility on the individual’.
‘There should be much more responsibility on the gambling industry,’ she says. ‘The gambling industry has to be made to pay for gambling disorder patients.
‘Saying “When the fun stops, stop” is the equivalent of saying “when you’ve smoked crack five times a day, stop”’
‘There need to be systems that stop people, like when you use your credit card abroad, or buy something unusual, you get a text from your bank. Why can’t that be done in an industry in which you have just spent £100 three times in the last day?’
‘With tobacco, it’s very clear. It’s not an association, it’s causation – it kills you. That’s simple, and it’s still been a hard battle against the tobacco industry. But once that incredible 1960s research was done there was no turning back.’
Professor Bowden-Jones says she ‘does not endorse’ what she calls ‘industry-friendly taglines made up by industry-friendly charities’.
Dr Molodynski puts it more bluntly: ‘Saying “When the fun stops, stop” is the equivalent of saying “when you’ve smoked crack five times a day, stop”.’
He suggests: ‘They could have disclaimers, like on
Professor Bowden-Jones adds: ‘This Government doesn’t like the idea of controlling people’s behaviours; it doesn’t like the public health approach we want to take.’ She says age verification and affordability checks are ‘vital’ to keep people safe.
With or without government and industry support, NHS services are expanding.
Dame Clare’s service treated about 150 new patients in its first year, and is on track for about 300 new patients in its second in addition to those still in care. There should be 15 clinics in Professor BowdenJones’s network by 2024.
The Government faces the kind of public health challenge that it should relish tackling – it is severe, affects large numbers of the population, but where it’s possible to have an effect without huge expense. What it can’t do, as any ex-gambler would tell it, is leave things to chance.
Do you become a partner or go salaried? It’s a question every GP has to answer. But one practice has found a third option, a ‘John Lewis’ model, where staff have shares in the practice. Ben Ireland explains how and why they did it
he question was, do we want to sell up or do something different?’
Ed Ford, a GP at Minehead Medical Centre in Somerset, had been a partner for 16 years before he and colleagues faced a big decision about the future of the practice, which looks after a local population of 13,000.
With two of its three GP partners looking to retire, and many other practices in the area ‘struggling to maintain the partnership model’ owing to workforce pressures, Dr Ford and his colleagues opted for something in between the salaried and partner models, an EOT (employee-owned trust).
ex-chair of Somerset CCG (clinical commissioning group) who acknowledged a similar shift in model up and down the country.
While maintaining the partnership model was ‘inconceivable’ in the current circumstances, Dr Ford notes: ‘Our staff didn’t want to be run by a faceless organisation. We didn’t want to rely on shareholders, and as partners we couldn’t hand it over.’
FORD : ‘Our staff didn’t want to be run by a faceless organisation’
This ‘John Lewis-style’ model gives every member of staff shares in the company, granted automatically once they have worked there for a year.
Of the practice’s 50-plus members of staff, five have been appointed trustees. At least one trustee must be a GP, but in Minehead’s case two are: Dr Ford, and deputy medical director John O’Dowd. The other three trustees are the finance manager, practice manager and an allied healthcare professional.
Dr Ford explains how ‘Somerset has historically been partnership practices’, but in recent years primary care organisation Symphony Healthcare Services, a subsidiary of Yeovil District Hospital and Somerset Foundation Trust, has taken on the operation of 16 surgeries at which GPs are salaried.
‘This wasn’t really the model I wanted to pursue for our practice,’ says Dr Ford, an
Minehead is believed to be the only individual practice in the country to operate an EOT model, though a group of surgeries in the north-west of England does so collectively.
Dr Ford says the move has ‘empowered’ non-clinical staff. Any remaining money at the end of the financial year can be spent, provided trustees agree, either on investment in the business, new equipment, more staff, pay rises or bonuses.
Non-clinical staff can buy into practices through the existing partnership model, but Dr Ford says discussions often create ‘tension about how much practice managers and nurses are worth compared to a GP’ and believes ‘not many people will be daft enough to buy into a partnership in the current climate’.
However, that doesn’t stop staff wanting leadership roles and responsibility, he stresses. And this is something he says the EOT model offers. ‘Once you level the playing field and everyone has a share, it makes it easier for people to make decisions. If you are a
pharmacist, say, in a leadership role, it becomes a lot easier because you don’t have to refer decisions to a partner.
‘In a partnership model, if you put people forward for these leadership roles, they would have to refer back to the partners who ultimately carry the can. We wanted all the staff to buy in and feel like they have a say in how the business is owned and run.’
For example, the reception team has already proposed changes to an infection control tick-box check list. ‘They can agree it with infection control, so they don’t have to wait for a partnership meeting,’ says Dr Ford.
And from his GP’s perspective: ‘The burden of having to be the one who everyone has to go to for every single decision has been lifted. If it involves the GP workforce, then obviously I’m still involved, but buying a bunch of flowers for a member of staff who is leaving – that doesn’t need my sign-off any more. Historically it did because ultimately that’s the partners’ money.’
Minehead’s trustees believe the move to an EOT model will help it recruit more permanent GPs and reduce its reliance on locums. There are five permanent GPs as well as five locums who usually deliver care remotely. Dr Ford says there has been success with non-clinical recruitment too.
He admits he is ‘probably earning less’ than before. ‘My accountants have questioned it,’ he says. ‘But it’s a conscious decision. I could potentially earn more as a partner, but we are still being paid well. The benefit is that the money I earn is mine. I’m not having to keep my money in the business to keep it running. We always paid ourselves [partners] a conservative amount each month because we never knew exactly what was going to happen so always kept money in the business. This way, I know what I earn. What I take home is my cash, and that’s it. You also remove the issue you have as a partner, that if you retire you may be stuck with a business you can’t leave.’
So how does a practice make the switch?
‘The key thing is to make sure to consult with staff,’ says Dr Ford. ‘There’s no point trying to do this if your staff aren’t on board. You also need to communicate with the ICB [integrated care board] and engage with patient groups and the local community. Make sure they are aware of what you are doing.’
For their part, NHS Somerset say Minehead’s application to be an EOT, being the first in the region, ‘has been subject to a robust and thorough evaluation’ and is hopeful it will allow Minehead to ‘continue to provide its patients with the best possible care’.
‘Best of both worlds’
The latest GP workforce data, published last month, shows a continued gradual shift from partner GPs to salaried GPs. In the year to August 2022, there was a 2% rise in the number of salaried GPs to 9,806, and a 1.9% fall in partner GPs to 16,764. This is in the context of a 1.1% (313) overall fall in the number of fully qualified whole-time equivalent GPs, to 27,515.
While BMA policy sees the partnership model as the ‘gold standard’, it states that salaried GPs should receive terms and conditions of employment which provide security of tenure, reasonable pay to reflect their experience, qualifications and work, fair hours of work, redundancy and leave entitlements as per the model salaried GP contract.
After Minehead was assured staff, patients and the ICB were happy, its lawyers switched the partnership to a limited company, then moved it to a trust model. Dr Ford told The Doctor he is now more content in his daily work life and can focus more on the clinical work he loves than the business side he doesn’t. He’s keen to share with GP colleagues that there is an alternative to being a salaried or partner GP.
His analysis: ‘It’s always been the case that, if you are a salaried GP, you go and do your job then go home whereas if you are a partner you can end up flogging yourself but maximise your income. This way, you have the best of both worlds.’
‘I could probably earn more as a partner, but we are still being paid well’
‘You remove the issue... that if you retire you may be stuck with a business you can’t leave’
MARKS: Principled and effective
John Marks, who led the profession in a passionate defence of the NHS against the incursion of market forces, has died at the age of 97.
Dr Marks was BMA council chair from 1984 to 1990. In 1989, Margaret Thatcher’s Conservative Government introduced a white paper which said, in Dr Marks’ words, that ‘efficiency in the health service could only come about through competition, in the so-called internal market, an unknown, untried and untested concept in a National Health Service’. It included plans for GP fund-holding and for hospitals to become self-governing trusts.
The BMA responded with a robust advertising campaign which portrayed a complete list of medical bodies supporting the Government’s plans (it was blank), a steamroller captioned ‘Mrs Thatcher’s plans for the NHS’, and, most famously, the question: ‘What do you call a man who ignores medical advice? Mr Clarke.’ Ken Clarke, then health secretary, often referred back
to the dispute with apparent bitterness in the decades that followed.
Dr Marks later reflected that the poster aimed at Mr Clarke may have been counterproductive as it was a personal attack, but 2,000 doctors joined or rejoined the BMA during the period, a majority of the public polled believed the plans would lead to NHS privatisation, and the pressure may have helped the BMA win important concessions.
Born in 1925, Dr Marks was the son of a poulterer turned publican. Despite being rejected by two London medical schools – one, he claimed, because he was not good enough at rugby and the other because was Jewish – he was accepted at Edinburgh University. He qualified on 5 July, 1948, on the very day the NHS began, going on to become a GP in Hertfordshire.
Dr Marks campaigned to protect the rights granted through the Abortion Act. He was strongly influenced by a despairing patient, Betty, who had, in 1968,
John Marks, who qualified on the day the NHS was founded, and went on to lead the opposition to Margaret Thatcher’s reforms, has died. Neil Hallows looks back at his distinguished career
PUBLIC
attempted an abortion at home, having no prospect of gaining one legally. In his autobiography, The NHS: Beginning, Middle and End?, published in 2008, he wrote: ‘I can still see that young woman lying dead on the bathroom floor with the syringe in her hand and her clothes raised up around her waist.’ This was just months before the Act came into effect. Dr Marks rallied support at BMA annual representative meetings when there were Parliamentary challenges to the Act, even though it exposed him at times to personal abuse.
He is also remembered, during his time as council chair, for leading the BMA’s response to the new challenge of HIV through the publication of a guide, ‘AIDS and You ’, in 1987. The guide won a Plain English Award for its sober and straightforward mix of words and cartoons about how HIV was spread and how it could be avoided. Again, there were elements of the profession and public which strongly criticised him.
When asked for his greatest achievement, he always gave the same answer – marrying Shirley Nathan in 1954. She also became a GP at his practice, and survives him, along with their three children.
Dr Marks described the NHS as ‘one of the greatest achievements in history’. He was one of the last to have been a doctor at the time of its foundation, and he spent a lifetime defending it.
BMA council chair Phil Banfield said: ‘John was an inspirational figure and exceptional advocate and campaigner who made a real difference to the lives and rights of doctors and patients.’ He described Dr Marks as ‘much loved and respected’, and that he ‘could only aspire’ to fulfil the example that his predecessor as council chair had set.
John Chisholm, the former chair of the BMA’s GPs and ethics committees, described Dr Marks as a ‘giant of medical politics’. He added that the practice Dr Marks had in Hertfordshire with his wife Shirley was ‘innovative, progressive and involved in medical education’.
Sir Sam Everington, a former deputy council chair, said that when he led a national campaign to reduce junior doctors’ working hours in 1989, the legal costs quickly escalated but ‘John took very little persuading to take over the case’. He added: ‘He never grew old and always understood the pressure on younger doctors.’
Former GPC chair Laurence Buckman was a trainee and later partner in Dr Marks’ practice. He said: ‘He knew all his patients and their problems, reciting them often when we were visiting patients at home. Underneath his gruff exterior, there was an empathic caring doctor, who spent much of his time increasing his understanding why his patients needed him.’
Former BMA council chair Chaand Nagpaul said: ‘John was a plain-speaking fearless man of principle and conviction and inspired me to get involved with the BMA. I also recall requesting the honour of him nominating me to stand for election on to GPC.’
A longer version of this article can be found at bma.org.uk/John-Marks
Latifa Patel, ST7 paediatric respiratory trainee based in the north-west of England on an out-of-programme career break.
BMA representative body chair
One of my aims is to increase the democratic input from our members, ensuring our policy is representative. I particularly enjoy the EDI (equality, diversity and inclusion) portfolio and elevating the voices of minoritised groups. Coupling these two remits together I have made it our mission to ensure our democratic processes are as inclusive and accessible as possible.
My primary role is to organise and chair our annual representative meeting. This is where policy is formed which directs the BMA’s work during the year. Last year, we held our first hybrid meeting. Over my term I will make our meeting more representative, more relevant and ultimately serve you better.
We have a retention crisis in the NHS. The lack of autonomy, and flexibility, especially for junior doctors, is driving our colleagues away. From the way locally employed doctors are treated, to the inflexibility in the undergraduate timeline, from the removal of rest facilities to the pressure colleagues are put under to cover rota gaps – the NHS has to do better and we are committed to holding those in power to account.
I want to emphasise the BMA is here for the profession, through its wellbeing and memberrelations services. Whatever your issue is, tell us and we’ll respond. Contact me at @DrLatifaPatel or RBChair@bma.org.uk
Emma Runswick, senior house officer working in older adult community mental health in Greater Manchester.
BMA deputy council chair
I am active in the BMA because I have a solid understanding of the good unions can do, and a recognition that medical students and doctors have not yet organised to their full potential.
My role as deputy chair of council is to make our union effective at improving our conditions. That needs lasting strategic and operational change in our union, to focus on collective bargaining and collective action that addresses our issues at work. We are shifting to be ‘an organising union’ and not just a service provider.
Our priorities must be: pay; pensions; working conditions, including for those outside the NHS; staffing; and workload.
We also need to shift our culture. I am prioritising anti-sexism and anti-racism work. I am pursuing increased transparency for our representative committees. Work needs to happen between meetings to achieve outcomes for members.
My message for doctors and medical students is one of hope. The situation is dire, but we have power together to change our lives, and to improve the care we provide. I’m the youngest ever chief officer, the second junior doctor (after Latifa) and the first LGBTQ+ chief officer who is out. The new chief officer team is the most diverse ever and we also have a radical agenda. We want to support you to win.
Contact me at @ERunswickBMA or depcouncilchair@bma.org.uk
Phil Banfield, consultant obstetrician in north Wales, and honorary professor in the school of medicine at Cardiff University. BMA council chair
As BMA council chair, I not only oversee the functions of the body tasked with enacting policy made at the ARM, but also the BMA board, which is responsible for the business strategy, practical working and financial operation of the BMA. I also am chair of trustees of our charitable arm, the BMA Foundation.
I represent doctors because I find it really difficult to stand by when I see injustice or discrimination – and I have got into regular and repeated trouble for highlighting these over the years.
Once I found that success became more likely, my ambitions to effect change increased and I’ve gone on from there. My role is to enable and facilitate the changes identified already within the BMA to increase representation, participation and presence in the workplace.
I also have a duty as board chair to build the business side of the BMA (in the face of significant financial challenges) so that we can achieve more for members in their workplaces.
I would like to get to a point where doctors, as highly skilled professionals, are asked regularly what they need to deliver the care they are being asked to provide – and it is provided. Doctors are the solution, not the problem.
Email chair@bma.org.uk
Trevor Pickersgill, consultant neurologist, University Hospital of Wales in Cardiff. Treasurer
I chair the finance committee, and lead on (among other things) estates, expenses, honoraria, reserves, accounts, and annual reports. I am a director of The BMJ too, one of our wholly owned subsidiary companies. I’ve held a number of representative roles, including chair of the BMA junior doctors committee, and I was part of the team that delivered the banded juniors contract (still extant in Scotland and Wales).
The main issue in the BMA right now and for the next few years is our financial position – we spend more than we get in through subscriptions and other income and we need to get to a position where we do not make a loss on our everyday activities. We have a working recovery plan, looking at areas such as estates, conferences and committees, and membership growth.
In terms of what I would most like to see improved about doctors’ working lives, it would be better pay, respect from colleagues and managers, and fewer managers (‘on tap not on top’ as we say in Wales).
As doctors we need more ability to feel we are in control of our workload and destiny. Fix the pensions tax disaster and many doctors like me would be happier overnight.
We are the most diverse chief officer team in the history of the BMA. We are absolutely committed to representing all of our members. We are here to listen, and we encourage you to get in touch, with your questions and experiences.
Email treasurer@bma.org.uk
In a West End play, Juliet Stevenson portrays a doctor who tries to act in her patient’s best interests but gets caught in a destructive media storm. The actor tells Seren Boyd why she identifies closely with her character
SITTING UNCOMFORTABLY: Juliet Stevenson explores the power of theatre to unsettle
If
only doctors were left to get on with medicine, immune to politics and culture wars. If only being a doctor was enough…
A divided society does not, however, allow that for Ruth Wolff, played by Juliet Stevenson in Robert Icke’s unsettling play The Doctor, now running in London’s West End.
Dr Wolff focuses entirely on her patient, a 14-yearold dying of sepsis after a self-administered abortion, insisting that the girl should not know she’s dying. So, the doctor bars a priest from reading the last rites.
‘If the girl had to die and I couldn’t save her, I wanted her to die calmly without knowing she was dying,’ says Ms Stevenson, speaking for and as Dr Wolff. ‘That’s all I could do for her in the end. She’s my patient.’
Dr Wolff holds fast to one identity: ‘I am a doctor.’ But in a society fractured by identity politics, she is cast in other roles: Jewish, white, woman. In closing the door to the priest, she unleashes a media storm that will ultimately destroy her career.
Ms Stevenson recognises Dr Wolff is flawed: she’s stubborn, authoritarian, uncompromising and, as the play hints, not entirely objective in her decision-making. ‘She’s not the moral heroine,’ says Ms Stevenson. But Dr Wolff pays over the odds for her intransigence.
Her very public undoing through TV debates and Twitter, a ‘woke’ culture’s witch hunt, is as disturbing as it is plausible.
of things like having to move surgeries online. It’s so wrong that doctors should take the rap for government mistakes and inadequacies and the chronic lack of NHS funding.’
Being able to explore potent themes ‘in the dark with a group of strangers’, within the safe confines of the stage, is what makes theatre so powerful, Ms Stevenson says.
However, she is aware real doctors don’t have the luxury of leaving these ‘best interests’ debates and ethical conundrums at the theatre door. All too often, reality mirrors fiction, in distressing cases such as the withdrawal of 12-year-old Archie Battersbee’s life support.
Ms Stevenson’s husband Hugh Brody is from a family of doctors. They have close friends in the medical profession and their daughter, Rosalind, is a medical student in London. Ms Stevenson has discussed this role with them at length.
‘So often doctors are on the receiving end of misdirected rage or grief,’ she says. ‘Doctors haven’t created the problem: they’re just trying to cope with the problem.’
‘So often doctors are on the receiving end of misdirected rage or grief’
Ms Stevenson first played The Doctor in London in 2019, winning the Critics’ Circle Award for Best Actress that year –then COVID blocked the play’s transition to the West End. The intervening years have only strengthened the polarising forces at work in society, making the play ‘not only burningly relevant but necessary’.
‘People are just yelling into their echo chambers: you select the truths that you want to hear and hate everyone who doesn’t agree with you,’ she says. ‘You can’t voice any opinion contrary to the mainstream.
‘Laying the play like a template over the last two-anda-half years makes you realise how much has changed in largely terrifying ways, how these forces which are shaping our society are out of control. Dr Wolff is not speaking to reason.’
She has found it painful to watch the way public perceptions and media portrayals of doctors have become distorted in the pandemic.
‘Two years ago, they were the nation’s heroes and heroines, because we were battling COVID, and now they’re on the receiving end of hate campaigns because
She has long been an ardent supporter of the NHS and last year threw her weight behind Your NHS Needs You!, a campaign against further privatisation.
‘Free medical care for everybody at the point of delivery is the greatest single thing about this country,’ she says. ‘So, what makes me angrier than anything else about this series of Conservative governments is that they’ve secretly privatised the NHS while claiming to support it. They have no mandate for doing this.’
Despite her accomplished acting career and strong involvement in human rights and charity work, Ms Stevenson describes ‘a long period’ in her 40s when she considered other avenues, fearing she wasn’t ‘contributing enough’. To her surprise, it was always to medicine that her thoughts drifted.
‘My overarching need in life is to feel useful. This play is useful: we need to tell these stories. I ardently believe the arts are important. But if you were in medicine, you’d never lie awake at night thinking: Is there any value in my job?’
The Doctor runs at the Duke of York’s Theatre, London, until 11 December. Reduced-price tickets in the stalls are available for NHS workers when selecting seats at www.atgtickets.com
I would like to welcome the new medical student and doctor members of the BMA – nearly 6,500 of you joined our association from July to September.
Our profession – and NHS – needs a strong BMA. We need a trade union which fights for better terms and conditions, speaks up about the state of our places of work, and represents us so we can care for patients.
This month, many of you will make your first subscription payments for BMA membership. The cost-ofliving crisis is making it a difficult time for so many people – many of us are making decisions about what we spend our money on and whether we need to change our habits.
These are issue on which the BMA is campaigning right now – including through a major pay restoration campaign. And the BMA is constantly advocating for medical students and doctors struggling financially.
In last month’s issue of this magazine, we told the stories of several medical students in financial difficulty, including sixth-year student Joe Tonge who is working three jobs – for his university, in a clothes shop and tutoring – to try to make ends meet, but still feels under great pressure.
In my view, it is probably more vital than it has ever been to have BMA membership at this worrying time –when our livelihoods and careers are more precious than ever. But, in case you aren’t sure, I would like to explain some of the benefits to membership of your union and professional association to ensure you get the most from your membership.
Immediately upon signing up to the BMA my top-three instant benefits to familiarise yourself with would be to have your contract checked, ensure you are familiar with the BMA’s wellbeing services and the relevant contact details are saved on your phone, and that you are logged into the BMA’s learning and development services – there are scores of free and discounted events and courses so you can learn at your own pace, wherever you are.
That contract-checking service is crucial and now is the right time of year to take advantage. Whether you have a new contract, you have just signed or yours is an older contract you never had checked it is important you contact us – you can do this on the phone or online.
This service means you can be sure what your rights are and that you are being treated properly. It also means the BMA, the only national negotiator of all doctors’ contracts, can keep tabs on how local employers are implementing contracts.
Our wellbeing services are available to you – 24/7 –whenever you need them. They are confidential services, free of charge. The services, which include six free counselling sessions if needed, are also available to your partner and dependants. As we head into another winter of undoubted crisis, with 130,000 vacancies in secondary care and 6.8 million people on the waiting list, we know there will be difficult times for all of us. Please do contact our wellbeing services whenever you feel you might need help or support. Our learning and development services can make a huge difference to your career too. You can access courses, events, The BMJ and the BMA library and so much of the content is available online.
There is much more to BMA membership. We will stand up for you if you are in difficult circumstances with your employer, colleagues or regulator. And if you need legal support BMA Law is available to you. Our legal teams, specialists in helping doctors, can support you in a wide range of areas from mortgages to wills. We also have partners to provide you with insurance advice and immigration advisory services. Help is available for so many areas of our working and personal lives.
Perhaps above all else, BMA membership is an opportunity to make your voice heard. Some 3,000 of our nearly 170,000 members are now in elected positions whether locally, regionally, nationally or internationally. Each one of those people is elected to represent you –to advocate for you. Please get in touch with them and allow them to amplify your voice – and consider standing for election yourself. Get involved and make the most of every aspect of your BMA membership.
You can contact me via email at RBChair@bma.org.uk
Dr Latifa Patel is chair of the BMA representative body
Highlighting practical help given to BMA members in difficulty
A consultant moved to a new hospital site and had a poor relationship with her clinical director.
Everything that could have been a problem –the new location, her job plan, and the relationship in general – was a problem. It was fractious from the beginning.
The consultant felt she was being bullied, and so took sick leave and did not feel able to return to work until the various issues were resolved. Just before going on leave, she had asked the BMA for support.
Sometimes these columns can seem as black and white as the words on a contract – and enforcing that contract makes everything better. Work that hasn’t been paid, for example, or conditions that have not been honoured.
This case was more subtle, and more about the need to provide continuing practical and emotional support.
Being on sick leave, the doctor was in a diffi cult situation as it is diffi cult to pursue a formal process practically, such as a grievance, and she felt unable to return to the working environment. Informal discussions with more senior management were not providing signifi cant help.
There was no miracle solution here, but the BMA employment adviser attended meetings and discussions and helped all parties remain calm and focused.
He made introductions to senior management, about which the member was initially nervous, but enabled her to have alternative forms of dialogue. She had a number of meetings of her own with
The Doctor
BMA House, Tavistock Square, London, WC1H 9JP. Tel: (020) 7387 4499
Email thedoctor@bma.org.uk Call a BMA adviser 0300 123 1233
@TheDrMagazine
@theBMA
The Doctor is published by the British Medical Association. The views expressed in it are not necessarily those of the BMA. It is available on subscription at £170 (UK) or £235 (non-UK) a year from the subscriptions department. All rights reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical or otherwise without the written permission of the editor. Printed by William Gibbons. A copy may be obtained from the publishers on written request.
The Doctor is a supplement of The BMJ. Vol: 379 issue no: 8356 ISSN 2631-6412
senior colleagues, and the adviser gave her help in preparing for them, discussing issues to cover and how to address them appropriately and succinctly.
The adviser’s job is to represent their member, but in doing so, they can be drawn into a broader role – something more akin to a mediator. Managers, including medical ones, can suffer from a lack of training and support, and often their knee-jerk hostility comes from the pressure they are themselves under, or a lack of full understanding of terms and conditions.
Members sometimes benefi t from advice on the manner in which they pursue particular arguments, in case they push managers in the opposite direction. It’s not (or not often) simply about the good guys vanquishing the bad guys.
None of this is possible without building up strong personal relationships and an ability to ‘read’ people, which the adviser displayed in abundance.
This is a column about ‘wins’ achieved on behalf of members and this case reminds us that it’s a win if the member sees it as a win, and if it’s the best possible outcome in the circumstances.
Here, the member did not return in triumph to her old department, all the problems resolved. Instead, she found another job elsewhere, which has given her the belief that her career is back on track.
She praised the adviser’s ‘outstanding professional expertise’, kindness and availability, and thanked him for his support during a challenging time.
Editor: Neil Hallows (020) 7383 6321
Chief sub-editor: Chris Patterson
Senior staff writer: Peter Blackburn (020) 7874 7398
Staff writers: Tim Tonkin (020) 7383 6753 and Ben Ireland (020) 7383 6066
Scotland correspondent: Jennifer Trueland
Feature writer: Seren Boyd
Senior production editor: Lisa Bott-Hansson
Design: BMA creative services
Cover photograph: Getty
Read more from The Doctor online at bma.org.uk/thedoctor
is vital we have up-to-date details for all of those who are entitled to vote. As well as your personal details, we must have up-to-date place of work information for all your workplaces.
missed ballot is a missed chance to have your say.
