The medical profession needs a voice

by Iona Collins
Consultant Orthopaedic Spinal Surgeon

I’d been a passive member of the BMA ever since Medical School, along with automatic membership of an indemnity provider. I used the BMJ to help with job hunting and enjoyed the articles, especially the Christmas editions. But, despite the challenges at work which I faced as a trainee, I never thought to check with the BMA regarding terms and conditions or workplace policies. To be honest, I thought that “going to the BMA” sounded like a bit of a threat and I didn’t want to rock the boat or draw attention to myself as a potential trouble maker.

Roll forward 20 years, when I was settled in my role as a consultant, feeling well established in my place of work. I thought that others appreciated the constant working ‘above and beyond’ in order to try and achieve the best patient outcomes and I didn’t seek any reward for all the extra time and effort beyond my contracted hours. Just like the rest of us, we all think we’re fighting the good fight as doctors loyal to the NHS.

One day, I had an email, just before going camping with friends, to say that my few days of annual leave had been denied. “Surely, this must be a mistake”, I thought, so I sought out the manager responsible for the email, only to be informed that my application had been made two working days’ short of the ‘mandatory’ six weeks’ notice. The fact that my leave was of no detriment to anyone was immaterial – what mattered was the computer receiving notification at the correct time and common sense did not prevail. When I tried to reason with people involved, I had responses like “if we give an inch, you take a mile” and “you all need clear boundaries”. I duly escalated and escalated, with eventual permission that I could, on this unique occasion, take my annual leave. I had spent hours trawling through health board policies and while the policies themselves sounded reasonable, their application on occasion was not, due to their misinterpretation by others.

This was my wake up call. I needed to actively engage with my union, since the union both knew all the policies and how they should be applied.

Shortly afterwards, I attended my first BMA Welsh Consultants’ Committee meeting, as a substitute for a colleague who could not attend himself. Sitting there, with doctors from all over Wales, discussing current issues in the workplace and establishing common themes, I felt for the first time ever that I could truly say what I thought about workplace constraints. My opinions were not falling onto deaf ears, and I did not need to worry about being accused of whistleblowing either. All those constraints which I had included in each annual appraisal could now be discussed productively, with intent to change the situation.

I looked forward to the opportunity to get voted into a BMA committee and when seats for Welsh Council came up, I asked work colleagues to vote for me and I campaigned on social media too. I managed to secure a seat on Welsh Council and I anticipated each meeting with enthusiasm, reading around the topics to be discussed on the agendas.

Attending the BMA meetings was a bit like looking under the bonnet of the car to see how the engine works. I learned about contracts, government policies, remuneration bodies, regulatory bodies, pension committees, tax, government health politics, investigation procedures among the many other topics discussed in detail. Each topic had BMA expert representation, including lawyers, accountants, mathematicians, statisticians… they had all the detail, but they were also able to provide the ‘headlines’. It was very apparent that no single doctor could ever know the vast amount of bureaucracy that influences our working conditions and contracts, let alone how health and social care interact in our Welsh NHS.

I could see how crucial the BMA was and how being a member enabled me to tap into this expertise, both as an individual and as a professional interested in the NHS as a whole.

I had no idea how much work the BMA was doing until I became a representative. I dread to think how much worse our situations would be as doctors in the absence of the vast amount of work that’s already been done by the BMA on our collective behalf. I also think, however, that if more doctors were members, the BMA would be even more effective, by representing a greater percentage of doctors.

Working with the BMA has taught me that my time is precious. Whenever I provide my time for free to the NHS, I am denying my family and friends that same time. The NHS will take my pound of flesh and more if I let it, since the job is never done fully and there’s always another test result to check, another letter to write, another email to answer. Even so, I sometimes still allow myself to be sucked into the machine and become a cog within it. I forget that if I dropped dead tomorrow, only my friends and family would grieve my passing. At work, someone else would simply step into my shoes and the work would continue uninterrupted.

We don’t look after ourselves and we certainly don’t stand up for ourselves. We worry too much about what others would think of us if we did so, but actually, I think that others would respect us more if we represented ourselves properly. The public sees us as leaders and I really think that we need to step up to the plate and lead together, through the BMA.

The BMA is a professional body and union which represents all members, but the BMA can represent all doctors if we’re all members. How powerful a voice can we be when we all come together? There’s strength in numbers and we’ve never needed our union more.