British Medical Association

The British Medical Association (BMA) is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association's headquarters are located in BMA House, Tavistock Square, London. Additionally, the association has national offices in Cardiff, Belfast, and Edinburgh, a European office in Brussels and a number of offices in English regions. The BMA has a range of representative and scientific committees and is recognised by National Health Service (NHS) employers as sole contract negotiators for doctors.

The BMA's stated aim is .[3]

"to promote the medical and allied sciences, and to maintain the honour and interests of the medical profession"

Currently 159,000 doctors and 19,000 medical students are members of the association. It is officially recognized by the British government and by the Review Body on Doctors' and Dentists' Remuneration. The BMA shares national bargaining rights with the Hospital Consultants and Specialists Association (HCSA).

Members of the BMA have access to employment advice, covering subjects including contract checking, job planning, pay disputes and relationship issues.

Members also receive a subscription to The BMJ, and other associated resources.

As part of the representative remit of the BMA it has a number of representative committees[4] formed from members elected at the Annual Representatives Meeting (ARM) and via other election processes. The most senior of these is Council. It meets five times a year to implement policy as decided at the ARM and to take relevant decisions during the year. Council has 34 voting members, led by the Chairman who is elected by council for an initial term of three years and to a maximum of five.

The Board of Professional Activities reports to Council and considers ethical, scientific, research, and educational matters whilst The Board of Representative and Political Activities considers reports from the following committees which represent doctors across the seven branches of practice which are:

Branch of Practice committees have a majority of BMA members but may also include non-members. All members are elected. These UK committees are mirrored across the devolved nations of Scotland, Wales, and Northern Ireland.

The BMA also has a number of committees which represent other specialities and interests which affect its members, including:

The Medical Ethics Committee[7] provides guidance to the association on current and developing issues in medical ethics. It is widely seen as one of the foremost authorities on ethical issues in the UK and international medical field. The committee debates issues of principle including those touching on:

Issues considered by the committee include abortion, organ donation and presumed consent, patient confidentiality, and the Mental Capacity Act.

The committee has eighteen members, composed of both doctors and expert lay members. Seven doctors who are members of the BMA are elected at the BMA's Annual Representatives Meeting (ARM) each year and three are elected by the BMA's governing committee, BMA Council, which also appoints four external members "drawn from disciplines such as moral philosophy, natural sciences or law." The Committee itself co-opts an additional four expert members, drawn from similar disciplines. The co-opted members do not have voting rights. The Committee cannot by itself set BMA policy, although it develops its own policy which has advisory status.

The Medical Ethics Department, which provides support to the Committee, answers individual ethical enquiries from doctors who are members of the BMA and produces guidelines and other publications. The bulk of the Department's guidance is freely available on the open access part of the BMA's website.

The BMA supports armed forces doctors through its Armed Forces Committee (AFC) which represents clinicians in all parts of the armed forces, whether they are deployed to war zones, acting as reservists or civilian doctors employed by the Ministry of Defence.[8] A large part of the AFC's work is the production of evidence to the Armed Forces Pay Review Body (AFPRB). The AFPRB advises on remuneration for members of the naval, military, and air forces. Further to this work, the AFC negotiates with the Ministry of Defence on the terms and conditions for civilian doctors.[9] The committee holds two conferences a year; an Armed Forces Committee conference usually in May and a Civilian Doctors' conference usually in October.

The BMA supports doctors that undertake private practice outside the NHS through its Private Practice Committee. This body considers topics facing both private consultants and general practitioners.[10] The committee meets three times a year and holds conferences in relation to private practice. The main issues currently being dealt with by the committee include looking at the implementation of revalidation in the independent sector and addressing difficulties that doctors experience in relation to new ways of working by the private medical insurers.

BMA House has been the headquarters of the BMA since 1925, the association being originally housed at 429 The Strand, London, since its move to London. In addition to offices for its staff the building is used for British Medical Association conferences and events[11] and parts of the building are available on a private hire basis for events.[12] The building, now Grade II listed, was originally designed for the Theosophical Society by Sir Edwin Lutyens with work commencing on 3 September 1911. However the start of World War I interrupted construction and the Army Pay Office took over the uncompleted building. After the war the Theosophical Society could not afford to finish the building, and it was sold to the BMA for £50,000, with the association later purchasing the freehold of the site from the Bedford Estates in 1962.

After purchasing the building, the BMA commissioned Lutyens to complete the building to its specifications. The building was officially opened by King George V and Queen Mary on 13 July 1925.[13] However, plans were soon commissioned from Cyril Wontner Smith to extend the building to overlook Tavistock Square. The association later commissioned Douglas Wood to design two more extensions on either side of Wontner Smith's front entrance (build 1938–1950) and one at the back of the building (build 1959–1960).

The British Medical Association traces its origins to the Provincial Medical and Surgical Association (PMSA), founded by Sir Charles Hastings on 19 July 1832. Ten years after its initial meeting the association's membership had grown to 1350 and it had begun to publish a weekly journal, The Provincial Medical and Surgical Journal. In 1853 the PMSA extended its membership to London doctors and 1856 transformed itself into the British Medical Association. From 1857 their jornal was known as the British Medical Journal or BMJ.

Although not initially formed with the aim of initiating medical reform, the BMA played a key role in the drafting and passing of the Medical Act 1858, which established the General Medical Council and set a standard for qualified and unqualified doctors and established a system of professional regulation. Prior to this anyone, qualified or not, could practice as a doctor. This also positioned the BMA to play a major role in future medical politics, campaigning on issues such as Poor Law Medicine, quackery, public health, alternative and military medicine, and contract practice. During this time one of the most active and influential of the association's bodies was the Parliamentary Bills Committee, formed in 1863 to take a leading role in influencing legislation on public health matters.[14]

In May 1911 the Government introduced the National Health Insurance Bill which presented the BMA with new challenges. This bill introduced the idea that for a maximum contribution of four pence a week every employed person in the country could be insured against treatment costs for sickness. The BMA supported the principle but had a number of reservations about the scheme including the lack of doctor involvement in delivering the medical benefits, which were instead being delivered by friendly societies and trade unions. In response the BMA produced "Six Cardinal Points" which it felt should be included in any legislation.

At the BMA's general meeting in July 1912, incoming president Sir James Barr condemned the National Health Insurance Bill as "the most gigantic fraud which had ever been perpetrated on the public since the South Sea Bubble." Addressing "a large and distinguished audience," Barr "spoke eloquently and forcibly in favour of the improvement of the race by attention to eugenics, and pointed out the necessity of preventing disease as well of curing it. No serious attempt, he said, had yet been made to prevent the race from being carried on by its least worthy citizens." Barr explained that: "If such an attempt was to be successful we must begin with the unborn. The race must be renewed from the mentally and physically fit, and moral and physical degenerates should not be allowed to take any part in adding to it".[15]

Ultimately the final bill was passed in 1913 in which four of the six points had been included. This resulted in an income limit of £2 per week being set to join the scheme, there was to be free choice of doctor by patient, the payment to the doctor should be adequate, and finally there should be adequate medical representation among the various bodies working on the Act.

With the start of World War I, the BMA formed a Central Medical War Committee (CMWC), and was given responsibility by the government for managing the demand for doctors in the armed forces whilst maintaining a full medical service for civilians. The BMA repeated this role during World War II. During this time the BMA also campaigned on issues such as the production and marketing of "secret remedies", nutrition and physical fitness, the relationship of alcohol to road accidents, and the medical aspects of abortion.

Early in the Second World War, the BMA became aware of the need for a change in the provision of medical care to the public after the end of the war and during peacetime, so shortly after the war, the BMA had produced its own plan for a "general medical service for the nation".[16][17] The plan had a number of revisions incorporating the latest BMA policy on various aspects of health care and in 1942 the Annual Representatives meeting approved a proposal for a state system "for the whole community" as suggested by the BMA's Medical Planning Commission. Later in 1942 the Beveridge Report announced a comprehensive national health service was to be established. The White paper "A National Health Service" was published on 17 February 1944.

Although the BMA agreed in principle with the establishment of the NHS, the BMA objected to the administration methods and the lack of consultation and negotiation with doctors regarding the scheme and the effects that the NHS would have on doctors' lives.

By 1945 a negotiating committee was set up and by 15 December 1945 it had announced seven principles with which the proposed service should comply if it were to be supported by the profession. The seven principles were;

Having gained a number of concessions from the government, the National Health Services Bill was published on 20 March 1946 and became law on 6 November 1946. The BMA conducted a referendum of its members to consider the Act. After 3 votes and a Special Representatives Meeting, the BMA Council recommended that the profession cooperate in the new health service and the NHS came into operation on 5 July 1948. The BMA has continued to play an important role in the NHS, specially in the negotiation of doctor's terms and conditions. The association also made a number of significant contributions to high-profile government reports during the 1950s and 60s, such as the Royal Commission on Marriage and Divorce (1951) and the Wolfenden Committee (1955).

The BMA continued to play an ongoing role in the reform of the NHS by contributing to a number of reports since the founding of the NHS. The Royal Commission on Doctors' and Dentists' Remuneration (1956) had important implications for general practitioners' pay, and was followed by a second inquiry – The Medical Services Review Committee. The report from this committee, known as the Porritt report was published in 1962 and included important recommendations for reforming the NHS administration, in particular the formation of area health boards. The third committee on General Practice was set up in 1961 under Annis Gillie and was charged with examining the future of General Practice. Its report was published in 1963. In 1965 the BMA published its General Medical Services Committee paper "A Charter for the Family Doctor Service".

The BMA continued to actively contribute to public health issues. The BMA's "Policy in Relation to Smoking" was published in 1971. In response to the perceived threat of nuclear war in the early 1980s, the association reported on the possible medical and environmental effects of global conflict. The BMA's first statement on AIDS was published in 1985 following the worldwide spread of the disease.

In 1989 the association rejected Kenneth Clarke's reforms of the NHS based on an internal market. Led by its chairman John Marks it mounted a public relations campaign involving newspaper advertising, a poster campaign, the issue of 11 million pamphlets for distribution by general practitioners, and radio and television broadcasts which were critical of the government's proposal. Clarke later conceded that the association won the public relations exercise.[citation needed] The government's legislation creating the internal market was implemented through the 1990 National Health Service and Community Care Act.[18]

In 1992, the genetic engineering working party culminated in the publication "Our Genetic Future", which considered the scientific and ethical implications of genetic engineering.

By the late 1980s, the BMA continued to negotiate contracts on behalf of doctors, some of them controversial[citation needed]. It has voiced concerns over the impact of European Union directives on the profession, devolution in the UK, new technological sources for medical advice, and many other aspects of issues affecting patients and the working lives of doctors. However, in recent years, in the wake of the 2016 EU referendum, the BMA has espoused the benefits of EU integration for doctors and patients, specifically through regulations such as the European Working Time Directive, research collaboration, medicine and equipment supplies, and increased freedom of movement, as well as increased public funds for the NHS.

As a democratic organisation, members decide BMA policy through the major policy making body, the Representative Body, which meets annually at the Annual Representatives Meeting (ARM). Membership of this body is approximately 600 and is elected both geographically and by branch of practice. Motions debated at the ARM come largely from BMA divisions (local bodies representing doctors) however they may also come from Branch of Practice or national committees.

In 2019 the BMA faced substantial criticism after two its leading General Practitioners blew the whistle on sexism and harassment at the BMA. [30] Following the Independent Romney review which described the BMA as “old boy’s club” that undervalued women, the BMA apologised to female doctors.[31]

The BMA makes grants to doctors for research and other reasons. Details of all the awards and grants offered by The BMA are available on their website.[32] However, the top three are listed here:

A charitable fund, administered by The BMA, that makes grants to fund the further education of medical practitioners predominantly engaged in general practice.

The BMA International Department runs the BMA Humanitarian Fund which offers grants of up to £3,000 for projects taking place in developing countries.[33]

The BMA awards ten grants totalling £500,000 annually. All grants are for research in progress or prospective research and cover a diversity of research areas.[34]

The logo of the BMA includes a stylised version of the rod of Asclepius, associated with Asclepius, the Greek god of healing. It was designed by John Lloyd (graphic designer) and Martin Skeet of the British design consultancy, Lloyd Northover.

The BMA Medical Book awards are announced annually. There are awards in 20 subject categories (from "Anaesthesia" to "Surgical Specialities"); special category awards including "Illustrated book", "Student textbook", "Young author"; and an overall "Medical Book of the Year".[35][36]