Tuesday, 8 July 2014

Letter of Resignation from the British Medical Association Council

 

Letter of Resignation from the British Medical Association Council


Dear BMA Chief Executive Keith Ward and BMA Chair of Council Dr Mark Porter,

It is with sadness that I have no choice but to tender my resignation from both the British Medical Association and the BMA Council after feeling bullied and intimidated.

When I ran for BMA Council in March of this year on a platform to support doctors, to fight against a 7/7 service, against pointless revalidation, 4-hour targets and CQC demands, I never envisioned I would come up against so many hurdles to represent as a Council Member elected by over 600 BMA grassroots members.

On May 20, 2014, even before I was to start Council, I was taken aback to be texted by Dr Mark Porter to meet with him at BMA House. I thought how did he have my mobile number? Maybe he just wanted to say Hi and welcome me to Council? Instead I was subjected to a 45-minute one on one interrogation on my proposed motion to ask the BMA to ballot its GP members on some form of industrial action (strike, mass resignation, OOHs boycott) of an untenable, financially unfeasible NHS GP contract that was leading many GP surgeries to bankruptcy and closure. I felt intimidated and set up to fail, as he told me, in his opinion, it was not an emergency motion for the Annual Representative Meeting. I explained that we could not have predicted the impending 99 GP surgery bankruptcies from MPIG and that this emergency motion was not discussed on my election statement, ie that it was new and postdated the close of ARM motions in April. He confirmed I would need 10 council members to propose said motion to BMA Council but told me he felt Council was not the place for consultants to debate a GP motion and that he would only listen to the GPC (General Practitioners Committee). During those 45 minutes I was interrogated on whether I knew when the council dates were and that I should, how often the BMA newsletter was sent, no not monthly but weekly, did I know his email, did I know Chaand Nagpaul's email, why did I tweet that only GPs should vote on GP matters, that I had missed the deadline for ARM motions, that industrial action was not for BMA Council to debate, that I should not waste consultants time debating GP issues on Council, that industrial action was for GPC and not Council, etc and at one point I interrupted him to say I am finding this very hostile yet he continued. I tried to explain I had received all the rules on submitting motions from the secretariat and that the GPC negotiated the contract and strike action was the trade union arm, ie BMA Council, as told by 3 GPC GP members.

After 45 minutes, a secretariat had to interrupt him to advise that he was keeping the E&D workshop waiting and she handed me an extensive print out of the code of conduct with my name penned on the top. He had kept 40 BMA members waiting for 15 minutes. I had been invited to attend the equality and diversity workshop as an observer by the subcommittee chair and had not been prepared for this impromptu one on one meeting with the Chair of Council before the workshop. I noted I had been singled out from the 18 elected council members. At the end of the workshop, he again cornered me and asked if I wanted to know more about the ARM. I declined as I felt bullied and undermined. I wrote a contemporaneous account and asked advice of my closest GP friends who advised me to put in a complaint. I rang the BMA employment advice line the next morning. I received an invitation to meet with the BMA President Sir Arulkumaran, a secretariat and a lay person. I emailed the BMA President a summary and linked it to the BMA dignity at work document that was included with the code of conduct pack:

1. Persistent unwanted criticism. Dr Porter had made me sit in a 45-minute meeting with him alone, singled out from all the other successful BMA council reps in this year's election and listen to his personal interrogation of me. I did not need to hear this as Nick Harrison, the BMA Council Secretariat, had been wonderful and emailed me answers to my questions on council motion procedures in preparation of writing a council motion myself when I start.

He continued to want to meet with me alone even after the equality and diversity workshop had ended at 3:30 pm. At this point I refused.

2. Inappropriate, aggressive behaviour. Dr Porter continued his unwanted interrogation even when I interrupted the 45 minute meeting with him to say 'I am finding this very hostile.'

3. Overbearing supervision or misuse of power. He singled me out of all the new council reps even before I had started work on Council, sent me an unsolicited text on my personal mobile phone to meet with him in his office and then chided me for wanting to bring a council motion on behalf of GPs I represent when I start on Council later this year.

4. Deliberate undermining of a competent person by overloading and/or constant criticism. In that 45-minute meeting with him, Dr Porter overloaded me with a series of criticisms, did I read the BMA news? Did I not know it was sent weekly not monthly? Did I know his email? Did I not get the dates of the council meeting? Did I not know Chaand Nagpaul's email? Yes you do know! 

5. Setting a person up to fail. 'You missed the April deadline for motions for ARM. No you cannot put in an emergency motion. I am the Chair. I decide on motions. Consultants on council should not be spending time discussing GP matters. I only listen to GPC (implying he will not listen to me on Council as a BMA council rep elected by over 600 BMA GPs).'

6. Setting unrealistic deadlines or demands. I told him I was informed by Nick Harrison that I could put in an emergency motion on the day at the June BMA ARM on behalf of GPs. Dr Porter said no, I could not. He contradicted the BMA secretariat. He kept saying the deadline was April for motions. I told him I was informed that emergency motions may be made on the first day of the ARM in June. I told him I was informed by Nick Harrison, I could propose a council motion if I could find 9 other council members to propose with me. He said he did not want to waste consultants time on council discussing a GP motion. He would only listen to GPC. 

He made it seem impossible for me to bring a council motion with him as Chair. I felt as though I was set up to fail as a council member representative for BMA GPs and that he was deliberately sabotaging my efforts to do my job on Council when I start after ratification on the last day of the AGM June 26.

I felt undermined, intimidated, bullied, and unduly criticised constantly in a 45 minute meeting in which he called me to, even before I had my induction on council or started work.'

7. When invited to a meeting with BMA President Sir Arulkumaran, no mention of bringing an advocate or industrial officer was offered to me as a BMA member. I accessed the BMA telephone counselling service as I felt stressed by both encounters. Two months have gone by and no apology or reassurances that I would be treated with dignity at work, instead I was told to keep the matter confidential!

8. In May I learned of the suicide of a mature Liverpool NHS GP partner from his university student son. I had met, taught and admired this GP. I was deeply upset and even more determined to fight for NHS GP partners. They needed a lifeline, a way to keep their practices solvent without burning out. They needed the NHS GP contract renegotiated as a matter of emergency before we lost too many GPs and GP surgeries to bankruptcy and closure. In my opinion, the survival of the NHS depended upon the survival of NHS general practice adopting a semi-private model as in Australia rather than an American HMO (Health Maintenance Org) model of profits before patients. The NHS needed to transition to survive the national public financial debt crisis.

9. I attended the June BMA ARM determined to fulfill a promise to Pulse GP grassroots readers to put in an emergency motion to allow GPs to earn like dentists, to ask the BMA help with alternative income streams to remain solvent and most importantly to ask for a ballot for some form of industrial action (strike, mass resignation or OOHs boycott) as leverage to renegotiate the financially unfeasible NHS GP contract that was bringing GP partnerships to an end. On the eve of the ARM, I approached Dr Chaand Nagpaul (GPC Chair) who kindly sat down with me and edited my emergency motion. I emailed it to Dr Tony Grewal (Londonwide LMC Medical Director) who modified it slightly also. He had advised me timing was everything for a strike. Too soon and it would have no effect. Too late and there would be nothing to save. And I even included mention of the May Pulse survey which revealed over half of GPs would consider a ballot on some form of industrial action. I found a seconder ARM rep, and submitted the emergency motion. The chair of the agenda committee GP Dr Helena McKeown advised me to reduce the wordage, so I did; she said reduce even further, so I did and turned it in. I also typed up the background to the emergency motion and handed it to Dr Fay Wilson. Two days later Dr Fay Wilson informed me that the agenda committee had rejected it, as they deemed it was not an emergency?! I said but what of the Pulse survey of GPs? She said the agenda committee does not take into consideration press surveys.

10. On the last day of the 4-day ARM, I watched the 4 chosen emergency motions being debated and was saddened to watch time spent to debate a toy BMA bear's sleeves with speakers for and against. I felt I had let NHS GP partners down. Our younger GPs did not have a 10-year government-protected generous NHS pension to fall back on. They had to work a NHS GP contract that was pushing many to burnout and bankruptcy. And with more female GPs than males, it meant many female GP mothers were putting in 12-hour days and sacrificing more time away from their children. I was saddened for patients who would be moved around when surgeries closed, the added strain on neighbouring practices, delays in accessing a GP, and the domino effect and collapse of healthcare.

11. On July 4, 2014, while on a one-week family holiday, I  received an email from the BMA Chief Executive Keith Ward with a detailed confidentiality 'gag' agreement, and a complaint letter with a snapshot from my restricted private facebook account that is only accessed by my family and closest GP friends. I felt violated and emailed back asking how the chief executive had gained access to the contents of my private restricted facebook account? It left me wondering whether the BMA had hacked my account? The snapshot was of my email inbox with headings. I was explaining to my GP friends that I was receiving BMA Council server emails as the server had not acknowledged my email away message, ie that I was on holiday. I did not want to be inundated with emails from the Council server and read a rant but wanted action for its BMA members. I had emailed the secretariat to remove me from the Council server as I was on holiday. Keith Ward's letter accused me of breaching confidentiality of the BMA Council server and suspended me from access and refused me council papers for July's council meeting unless I signed the 'gag' agreement. The contents of the server were never posted on my private facebook, just my email inbox photo to demonstrate being inundated with BMA council server emails even on holiday. For me, my restricted private facebook was a place I felt I could offload stress and ask my closest colleagues for confidential advice. I was overcome with feelings of upset and violation.

12. I have listened to and helped many NHS consultant whistleblowers. I was all too familiar with the methods used by some trusts to remove consultants and feel that I am being subjected to similar methods of intimidation, gagging and exclusion.

I feel that I am forced to write this letter of resignation even before I have attended my first Council meeting because of my experiences to date. I feel that the BMA structure is such as to make it impossible to represent doctor members and I also feel that I have been treated in a way that has been repeatedly undignified. 

Regards,

Dr Una Coales BA MD FRCSEd FRCSEd (ENT) MRCGP (2003) DRCOG PGCertMedEd
Served the NHS for 18 years, the last 11 as a NHS GP.

Excerpt from the BMA Chief Executive Keith Ward's letter dated July 4, 2014

'..I am not in a position to authorise mailout of the July Council papers to you. However, I do not wish to fetter your engagement with BMA Council and will be prepared to forward the July Council papers to you upon receipt of a formal undertaking (attached) to treat the Council documents marked confidential as confidential. Secondly, I have asked the Director of Legal Services to set up an investigation and also call an Interim Measures Panel Article 14 (8) who will be able to assess the likely ongoing risk to the Association whilst the investigation is underway and also potentially have the power to suspend you from all BMA offices you hold with immediate effect pending the outcome of the investigation.'

Update 21 August 2014


Evidence from my restricted private Facebook used by the BMA Chief Executive to call for an Interim Measures Panel. How did the Chief Executive gain access to my restricted facebook? Are the actions of the BMA 'disproportionate' to ask the Director of Legal Services to call for an Interim Orders Panel to assess my ongoing risk to the BMA? Are Nationally-Elected Council Reps to be 'gagged' from talking to their electorate and expressing an opinion about being inundated with BMA server conversation emails on holiday?



Response to Data Subject Access request for identity of my accuser. BMA redacts his name. The Royal Crown Courts abide by the laws of natural justice and allow one to know the name of the accuser to respond to any 'vexatious' complaints, but not the RCGP or BMA. It begs the question, are old boys protecting each other? Is the BMA a closed shop?




Update October 2014

 
The BMA should reflect back to 2002/3 when a national ballot of all its GP members on 'undated mass resignation' was used successfully as powerful leverage to renegotiate a fairer NHS contract for state GPs. This was what I was asking of the BMA of 2014 for our generation of worn-out GPs Click Emergency BMA ballot on behalf of NHS GPs to save general practice before it was too late and we lost our profession forever. I leave you with messages and comments from countless NHS GP partners crying out and asking for help. If their trade union will not take action or allow a GP ballot on some form of industrial action, then we may be seeing the end of the profession of general practice.
 
Daily Mail article of the BMA ballot in 2002 asking 36,000 GPs if they would be prepared to submit an undated resignation letter in April next year.





NHS GPs call on their BMA trade union for a 'ballot on action.'

 
Ex NHS female GP Partner, 'Dear Una, I read your columns in Pulse regularly and I think you are right in asking for global action: we really need to have our voices heard. I am 52, a GP in X and recently took a partner position only to resign 6 months on. I do not want to be a partner ever again, it is a crazy life!

I wrote to Jeremy Hunt who...has not a clue how many hours we do and the amount of stress we are under. I am seeing Ann Milton, our local MP and previously the Health shadow minister but don't expect too much from it.

I have resigned the BMA as I feel they are not supporting us, and I am not sure about the LMC...

Let's hope our voices get heard before the profession dies.' September, 2014.


UK GP registrar, 'Dear Dr Coales, I was hopeful for the future of general practice, but now I see a specialty that appears to be deteriorating before my eyes. I completely agree that GPs are being bled dry by a contract that is just incredibly out dated - I fail to see why I or any other prospective GP should face a future where we are paid so poorly in comparison to hospital specialists (who only have their narrow remit to deal with), and where we are constantly denigrated in the national press, and by lay people on the street. It makes me so angry!

Today I have just learned of the extortionate fee for the CSA also! What a slap in the face to erect this financial barrier to those who have already sacrificed much and face a worsening future. This one exam costs more than my entire MRCP did - I fail to see how that fee can be justified.

Essentially, my question boils down to this: Do you still feel there is a value in qualifying as a UK trained GP, or would I be better served trying to find my peace with a hospital specialty? I would consider taking a CCT in GP abroad, would certainly consider practising privately, and would even consider returning to hospital training post GP CCT if there is further deterioration in GP working conditions and pay.'


Ex- NHS female GP partner, 'I have left an excellent partnership because of their (government) policies and could not, in all honesty, advise any young doctor to choose general practice as a career.'

NHS GP partner, 'Honest debate is this - our workload has gone up 50% and our pay has fallen by 25% in 10 years ie £80 for 4 consults (£20 each) has become £60 for 6 consults (£10 each) - which is a straight forward 50% pay cut per item in 10 years. No other group in the NHS has had to endure such a savaging of their pay and pensions. Honestly, you would be mad to come into General Practice where they impose Contracts (there is a misnomer!) and cut seniority, MPIG, pensions at will. Of course, there is no money, except when it comes to increasing MP salaries by 11%. STAY CLEAR OF GP LAND - HONESTLY.'


Sessional/locum NHS GP 'Honestly, my advice to any young doctor...KEEP AWAY FROM GENERAL PRACTICE!!'


NHS GP Partner 'Once the domino effect starts, the DOH and NHSE will be forced to address the appalling work conditions. A+E would not be able to cope.'


NHS GP Partner 'My GP trainer and later fellow Programme Director took his life (2013)..at the age of 51.'


NHS GP Partner, 'No one has the right to expect us to work 12 hour days ( for £72 per year's worth of healthcare.'

Ex-NHS GP partner 'I left my partnership in December (aged 53) and have absolutely no intention whatsoever of working 12 hour days, 7 days a week. Good luck with finding a sufficient number of people who are. If anyone asks me why I left, I will tell them that I found life as a full-time (NHS GP) partner intolerable.'


NHS GP Partner '£10 is the amount the practice receives, not the GP and at least half of that goes in overheads. There are patients who contact the practice every single day and some who request a home visit every single day and complain to PALS if they are refused. Others have appointments twice a week, every week. Incidentally, this was negotiated when the average (consultation per year) was 3 per year, not 6.'
 
 
Ex-NHS GP Partner, 'Ex partner here escaped as well with almost 15 of my colleagues partners/salaried. All probably keeping UK registration so won't feature in the statistics till it is too late. A football team in the sun. Come along.'
 
 
NHS GP Partner, 'I'm not going to lie to other doctors about how awful GP has become, no matter who tells me to. We have a duty to whistle-blow. I'm voting with my feet I'm afraid.'


Female NHS GP partner, 'We need a union specifically for GPs.'


NHS GP partner, 'Why won't those naughty GPs simply be quiet whilst I beat them with my cane of income reductions, pension contribution increases, retirement age increases, regulation increases, workload increases, and patient expectation increases?'

NHS GP partner, 'My last year as a GP has been soul-destroying, so escaping, initially to locum, then abroad.'

NHS GP partner, 'Isn't £100 million a year divided by 67 million people approximately £1.50 per person in the country per year to provide this (7/7) service. These people do not live in the real world.'

NHS GP partner, 'No funding increase for 6 years and abolition of MPIG.'

NHS practice manager, 'With no extra staff, to open at weekends we have to close during the week. Without a huge amount of money, in £billions to pay wages for extra staff, there is no extra staff to open at weekends. Even if money was available, there aren't enough people to recruit. There is a crisis right now with not enough GPs for the existing number of posts let alone additional ones. It's very hard to find a replacement practice nurse, and the District Nursing srevice in my County is in free-fall collapse as they all get out as fast as they can and no-one comes in to replace them, and I really mean zero applicants for the advertised replacement!'


NHS sessional GP 'We can't magic GPs out of thin air!'


Female NHS GP partner, 'This year more than 800 GP recruitment places were not filled. Partners are retiring left, right and centre. I'm certainly looking to defect. Not worth working in the NHS anymore. Patients aren't even grateful.'


Female NHS GP partner, 'I have no problem with 7-day access since my exit strategy is my one way ticket to Australia departing December 2014.'


NHS GP partner, 'A consultant colleague of mine is leaving hospital medicine - as consultants are now expected to be involved in on call more and more, causing a problem with work/life balance. I'm sorry but general practice cannot go back to 20 years ago when we did 24 hour on call, 1 in 4. Demands and expectations of the patients are now difference and 8-8, 7/week would not be manageable with the current funding/work force.'


Ex NHS GP partner, 'For me, I resigned as a GP partner and am a portfolio GP for the past 9 months. Have seen a change of situation and feel I can control work. If things get worse, goodbye to General Practice in the UK and yet to decide ? Canada ?Australia.'

NHS GP partner, 'Unless we all have the b***s to threaten to resign from providing services, which is not a new concept, then we will continue to be treated as s**t. Our decision and one we must seriously consider if anybody is going to listen to the state we currently find ourselves in. We need to now play hard ball the same way we have been treated - every man for themselves. GP can't continue in this way - denigrated by all and sundry, yet undertaking 90% of all of the NHS contract. We deserve better and we aren't going to get it by playing 'nice guys' as this doesn't work with the current administration. Fight fire with fire and let them know we mean business.'