ARM 2023 welcome address

Good morning, RB, friends, colleagues.

A year ago, I stood on a very similar stage and I made a promise to you.

I promised that the BMA would back you. That through hard work, courage, determination, we would no longer be cowed by any government, by any employer, or by any regulator. That together we had rediscovered the strength of our profession’s collective will.

That all the effort put into balloting, picketing, ward walking, campaigning – the collective efforts of our members - would start to bear fruit.

Above all else, I promised a new era for the British Medical Association. One where we reverse the decline of the medical profession. Where we recognise our worth and fight for it.

What have we delivered?

Well, Stormont knows...

Earlier this month resident doctors walked a mile down Prince of Wales Avenue, past the streetlamps and the lime trees to the seat of Government, to issue their demands for full pay restoration. Resident doctors – for the first time in history – have been on strike in Northern Ireland.

Consultants in Northern Ireland also made history. For the first time they organised, balloted, and delivered a gargantuan victory for strike action, with the backing of 92% of members - the Northern Ireland Executive has seen sense, offered immediate talks, and the strike action planned for this Wednesday in Northern Ireland has been called off.

With an indicative ballot showing that over 86% of Northern Ireland SAS doctors have now called for industrial action, they have a formal ballot opening any time now.

Holyrood knows...

The organisation of resident doctors in Scotland led to a 12.4% pay rise and negotiations to restore pay over the next three years. Scottish Government have once again responded to doctors agitating, in order to head off industrial action in Scotland.

But despite consultants attempting to work collaboratively to address the 30% pay erosion they have faced, the lack of progress by the Scottish Government means they too are gearing up to ballot.

The Senedd knows….

Successful ballots and strikes in Wales too. As I speak, a pan-branch of practice offer for resident doctors, SAS doctors and consultants in Wales, delivering higher pay awards along with contractual reform, is being voted on, with the results in a few days’ time.

Even the Westminster government recognised our strength.

Last year, the BMA secured outstanding reforms to pensions - for all doctors.

Now, after months of historic campaigning, balloting and, in the case of consultants, unprecedented strike action, we have delivered new pay deals for consultants and SAS doctors in England, worth hundreds of millions of pounds.

Our consultants committee also fought hard for changes to the doctors and dentists’ pay review body (DDRB), which had increasingly become a fig leaf for the government’s policy of driving down wages.

This means the DDRB will have to consider historic losses of pay that doctors have faced in the future. Both the pay review body and the government must face the consequences, if they fail to deliver on 15 years of pay erosion.

These changes benefit all working doctors going forwards.

But while Government has settled with consultants and SAS doctors, residents in England remain locked in a bitter dispute, with 5 more days of strikes starting Thursday.

Through the hard work and yes, through the audacity of the junior doctors committee – or as they will more likely be known by the end of this ARM – the BMA’s resident doctors committee – an initial offer of 3% was pushed to over 10%. Yet this still fails to address the huge real-terms decline in pay that resident doctors have faced.

We have proved that we can resolve disputes through negotiation. Even the Conservatives can do it when they try. They had their chance and blew it with our lowest paid doctors.

But I have a message for Rishi Sunak. Calling an election does not get you off the hook. When resident doctors take industrial action once more this week, you must answer for your vague and empty promises that have resulted in endless procrastination and talks without a purpose.

Rob and Vivek wrote to the PM last week, with a simple request to recognise lost pay for highly qualified doctors on just £15 per hour. He hasn’t even bothered replying. Victoria Atkins posted on social media to repeat the trope of lies they have spun all along, trying to demonise the doctors.

RB, this Government, sadly, has displayed unbelievable hypocrisy and contempt when it has come to resident doctors and therefore the patients they serve.

Even the Conservative leader of the House of Commons, Penny Mordaunt, has stated that ministers should have resolved the resident doctors strikes.

Mr Sunak still says he can’t afford to pay doctors their worth, but what a ridiculous argument when you’ve spent more than double the cost of full pay restoration covering industrial action.

It has been HIS choice not to resolve the longest dispute in the history of the NHS. It’s been on HIS watch; HIS National Health Service in crisis; HIS decision - and probably HIS loss.

Ultimately it is deeds, not words, that will end this dispute. And it is deeds, not words, that will guide our relationship with any new Government.

Just as the BMA has led, and will continue to lead the fight for pay restoration for its members, now is the time we also bring the full force of this association behind general practice.

I have said it before, and I’ll say it again, general practice is not the dumping ground for all the issues faced by secondary care, and that’s me saying this as a hospital consultant married to a GP partner.

With record demand on GPs, it has been an act of vandalism to plunge general practice into such dire straits.

Nothing highlights this crisis more than finding that a shocking 84% of locum GPs in England are struggling to find work. A third are being forced out of the NHS entirely. Driven out by the cheapening of the medical workforce and the substitution of GPs with alternatives that superficially seem less expensive, but in reality cost lives.

A lost generation of GPs when the country needs them now more than ever.

To have highly qualified doctors turning to other jobs to earn a living, whilst GP practices cannot meet the demands placed on them, is simply bonkers.

The state of general practice around the UK is a mess - created by those in power, who have not only watched, but aided and abetted the decline of general practice, and with it, the morale and goodwill of GPs.

The ARRS scheme in England, which prohibits practices from hiring doctors, is a Trojan horse sent into the heart of general practice to replace and substitute doctors.

Where we need a physio, fund a physio; where we need a paramedic, fund a paramedic; where we need a doctor – fund a doctor!

In England, our general practitioners committee referendum on the 24/25 contract returned a resounding 99.2% vote against it.

Contractors and partners are now being balloted to help determine the collective action they will take to resist yet another derisory contract.

While in Wales our Save Our Surgeries campaign goes from strength to strength.

Yes, the BMA machine will ready its engines and drive the change needed to restore general practice to its rightful place; to the centre of our health system, back to being the sparkling jewel that it once was.

We will not stand idly by to let standards of healthcare be driven down, nor accept shortcuts being imposed at the expense of patient safety.

Why has the medical establishment caved into the Government’s spurious attempts to reduce cost at the expense of people’s health? And why does it feel too often like it is only the BMA shouting out about patient safety?

I hear our members ask, “where are our royal colleges”?

Supposedly driven by patient safety, but seemingly more concerned about ‘being around the table’ while not realising that they have been on the menu. “Why”, our members ask repeatedly, “is medical leadership in this country in abeyance?”

Those in positions of power and influence have a question to answer; why haven’t you listened to your doctors?

RB, WE represent YOU, and 193,000 more doctors.

Yes, we have settled some disputes, securing the most substantial and transformative wins for doctors in a generation, but we still have our battles ahead. And we are not complacent about the prospect of a new Government.

But, my friends, you voted for change, and we’re not stopping there.

Our national disputes necessarily depend on our local representatives and members. It’s time to harness that local energy, to harness every reinvigorated and passionate member that fills our ranks. Let’s back them by giving you more tools locally to fix what is broken in our workplaces.

For too many years we have been an association that provides services when things go wrong. But, we are becoming a BMA that organises and wins;

A BMA that stops qualified doctors being replaced with less skilled alternatives;

A BMA that challenges the destruction of doctors’ careers if they speak up about patient safety;

A BMA that challenges employers who too often think of terms and conditions, contracts and employment rights as ‘nice-to-haves’ rather than their legal obligations;

A fighting BMA that YOU can be proud of.

RB, that time is here.

Time to make a day-to-day difference to your lives and the lives of the thousands of doctors you represent.

Just how will the BMA do this, I hear you ask? That gentlemen’s club. That old boys’ leopard that can’t change its spots organisation? And anyway, people have tried and failed before?

Well, the BMA already HAS changed – and you RB are at the heart of that.

I bet many of us thought we’d never be here just 5 years ago. And half of the chief officers women, and resident doctors to boot – two of the most talented and remarkable women - doctors - I have ever had the privilege of working with.

In your BMA you can be who you truly are. You can be gay or pregnant or breastfeeding, of some faith or none, of any gender and any ethnicity. We want you all to succeed in your reinvigorated BMA.

Latifa is incredible; as if chairing the RB isn’t challenging enough, she has taken on the GMC over inequalities and racial bias, and the rest of the world on medical neutrality and humanitarian crises; she has broken a glass ceiling that was cracking, but stubbornly still in place. She has done this with patience, and compassion, and as a new mum - she has challenged the BMA to adapt - and it has.

And Emma brings unbelievable energy, knowledge and experience of how to organise; how to deliver what you, RB have been complaining that the BMA lacked – the re-establishment of the collective voice of the medical profession. How to be the effective modern trade union you have demanded.

With Trevor, Neeta and Rachel, we work for you, RB. We only ever do what you have asked of us.

In 2022, RB, you voted to remove our reliance on divisions and fundamentally change the BMA by creating new structures embedded in your workplaces.

At this ARM you have the chance to vote for these new structures. It is time to move from consultation to implementation.

These structures are centred around your workplaces and wider communities, catering for students and for retired members, GPs, and across the primary and secondary care interface.

RB, I understand that the speed of change has taken some of you by surprise and I’m sorry that we don’t always get our communication right - but by deciding to support these changes you can turbocharge our efforts to be the mass membership organisation we need to be, with the even greater membership density in your workplaces, that materially boosts leverage with employers - that is there for everyone, not the few.

We have already shifted resource into training local reps, but we now need the local structures to ensure we’ll be more visible than ever.

Crucially, these new structures will enable us to tackle issues that matter to members much earlier. Just as in medicine, preventing problems before they become incurable and terminal, is better for everyone.

All our struggles have taken place against the backdrop of a crumbling NHS. The BMA has been raising concerns about the parlous state of the health service across the UK for over 15 years.

As doctors, we reach for the stars of professional excellence – but the human body is infinitely less predictable than any NASA spacecraft. Our unpredictable world is proving even more difficult to navigate safely – health and social inequalities are widening - our health system has become unstable, tumbling earthwards in turbulence and freefall. You can only crash land so many times before the luck runs out. Doctors train to prevent, minimise and mitigate for errors and the inevitable unexpected.

However, openness and transparency, and the no-blame culture needed for investigation and future prevention, have NOT come into being post-Mid Staffs.

Ten years ago, Don Berwick said that: “NHS staff are not to blame” and that “operational targets and financial management have taken precedence over delivering high quality care.”

Francis, Berwick & Kirkup shed much needed light on institutions avoiding openness and transparency.

Ten years ago.

Let me tell you RB, the same is still happening in our hospitals today.

The system has already FAILED when whistleblowers are forced to speak up, but we have more and more doctors approaching the BMA, desperate to highlight cover-ups.

Six years on from the BMA asking you about raising patient safety concerns, we asked you again.

The results? Far fewer doctors are confident in speaking up than they were six years ago. In 2018, almost half of doctors said they would feel confident raising concerns in their place of work.

This year, that figure is just 31%.

In 2024, over 60% said you were scared to raise patient safety issues for fear of reprisals. That’s 10% more than six years ago.

Things are getting worse.

Look at the data published by RCEM in April suggesting 300 deaths per week may be due to long waits in emergency departments. That’s a plane full of people. It’s grandparents, parents, siblings, not a statistic to be noted and dismissed.

Isn’t that scandal enough?

I said that the BMA will not stand idly by as employers try to silence those who raise concerns, and it has not. Have we learned from Letby? I fear not.

Pandora’s Box is about to be thrown wide open. This is far bigger than the Post Office scandal and the BMA will do all it can to help uncover wrongdoing.

You have come forward to your union because you are so fearful of your employers. We will create the safe space you have been denied. We owe it to you, and we owe it to our patients.

The transformation of the BMA YOU are voting on RB will allow us to help more of you to raise concerns - to help protect you while, not after, you make a protected disclosure - and be with you so that you don’t suffer detriment in the first place, let alone when you have to try to prove it in hostile tribunals.

Those who run NHS organisations must, like doctors, be accountable for their actions and for the decisions that they have made. In some cases, it has been alleged that poor performing NHS executives have been conferred a degree of protection by NHS England, shuffled out of prominent roles and into other senior positions.

This is a disgraceful revolving door of ineptitude.

That’s why we’re backing the regulation of non-medical managers. Because as long as this culture of protectionism, rather than accountability, holds sway, doctors will continue to face appalling victimisation.

We continue, RB, to fight FOR change and AGAINST employers trying to silence those who dare to speak up.

On that note, you spotted the pass the parcel of shirking responsibility, and we stopped the music. MAPs. YOU spoke up to highlight what was really going on, and we highlighted just how widespread the misuse of Medical Associate Professionals has become.

You asked us to fill the void in patient safety. We shouldered the accountability.

Over 18,000 doctors reported their experiences to us – 87% had observed MAPs working in ways that are a risk to patient safety.

NHS England says MAPs are not doctors, but propose no ceiling on their scope of practice. How they can entertain both positions makes no sense.

And we keep seeing examples of PAs being called ‘physicians’ or ‘specialists’. This is not just misleading the public, it incites a criminal offence.

The argument that MAPs provide different skills to the multi-disciplinary team, does not stack up.

Please, if you want to be a doctor, go to medical school. But to every MAP assisting doctors across the UK, I say thank you for helping us with our patients. I want to take this opportunity to remind everyone in our teams, that civility saves lives.

Doctors’ expertise is unique. We undertake the extraordinary every day with incredible skill. It is not by accident that our GPs can manage such medical complexities from the cradle to the grave in our communities, or cardiologists stent the tiniest vessels of the heart to restore blood flow, function and life, or obstetricians to perform life-saving surgery to stem a massive obstetric haemorrhage at 4 o’clock in the morning. I could equally list thousands of actions undertaken daily by doctors and ONLY by doctors, underpinned by our extensive and arduous training.

Look, just because the Government has waved through GMC regulation does not mean the battle is over.

We continue to demand a repeal of this legislation, so that a more appropriate regulator is put in place.

We will lobby for a return to the term ‘assistant’ and not ‘associate’.

We will continue to argue for the implementation of the BMA’s safe scope of practice and supervision guidance for doctors. And locally, nothing is off the table.

We will not back down in our call for a halt to ANY further recruitment of MAPs until the medical profession’s concerns are fully addressed.

If others won’t lead, WE WILL.

Today I want to announce that we are taking legal action against the GMC - over their dangerous blurring of the lines between doctors and MAPs.

Specifically, we are challenging their frankly unsafe use of the term ‘medical professionals’ when referring to people who are not doctors, and that Good Medical Practice cannot be common to both doctors and MAPs.

This legal action is supported by our colleagues, the grassroots movement Anaesthetists United, who will be pursuing a complementary legal challenge.

We have had enough of the Government and NHS leadership eroding our profession. We are standing up for both doctors and patients to block this ill-thought-through project - before it leads to more unintended patient harm. It’s not too late to row back from this uncontrolled experiment in dumbing down the medical skills and expertise available to patients.

RB. I hope you agree that your BMA is delivering what members want.

But, what of the future? Waiting lists wait for no-one – the need to get doctors clearing the backlog is immediate. The cost of doing so is an investment in the future health and wealth of this country –

The Times reported the benefit to be £73 billion.

With the right leadership, the right investment, our NHS can recover the good will and morale this Government has incinerated. It is our healthcare workers who have been left burned out and exhausted and it is for the next Government to retrieve that position. This will need honest and serious commitment of engagement with the medical profession. We’re here to lead and help.

So we take our fight to the workplace for the future of medicine and health of our patients.

The public will take the fight to the ballot box, for the sake of those they care about most.

Make no mistake, we will be judged on the decisions we make about whether we transform our union. Judged on whether, this week, we give this great profession its fighting chance.

I started today by recounting the promises I made to members a year ago. I said we would strike to the general election if necessary. They said it couldn’t be done, yet look where we are.

Now let me make another. We will not halt the progress we have made or shy away from the battles ahead.

With head, and heart and hand, we lay new foundations to build our fighting union and rebuild our NHS.

The profession wants it.

Our patients need it.

Our members demand it.

Our unity is our strength.

In an uncertain world, one thing is certain – our patients need doctors.

RB – I move.