New BMA Scotland chair will ensure doctors are heard

As the newly elected chair of the BMA in Scotland, Dr Peter Bennie is mindful that he is taking the reins at a crucial point in Scotland’s history. And with the NHS such a key part of Scottish society, he says he isn’t surprised to see it emerge as a focal point in the latter stages of the referendum campaign.

South of the border, recent reforms to the health service brought about through the Health and Social Care Act 2012 have been “very strongly resisted” by the BMA, Bennie tells Holyrood, “and quite rightly so.”

He explains:

“If you want to encapsulate it in a nutshell, the model of the NHS that we still have in Scotland is reasonably close to the original plans, whereas the evolving model in England is becoming ever closer to an American-style health service. And all the evidence is there for how inefficient that kind of health service is. So it doesn’t come as a surprise to me that the health service has come up as an issue towards the end of the referendum; it is so important to so many people in Scotland.”

However, he says BMA Scotland takes the view that it would be “wrong” for the association to take a position on the referendum and to try and influence the vote in either direction.

“We are a membership organisation. It is highly likely that our membership has the similar breakdown of opposing views – either yes, no, or, crucially, don’t know as the general population. So it would be wrong of us to take a position one way or the other.”

Instead, he says they have chosen to focus on what comes next, whatever the result.

“What we are focusing on is once the decision has been taken either way, we will be pushing very hard on the key issues for the health service and for the health of the public, which have always been our focus.”

Bennie’s new position comes with “big responsibility”, he says, with his primary role “to make sure that the doctor’s voice is heard and listened to, including, very crucially, by government and the other political parties.”

In the past, the association has shown that it can support and work constructively with the Scottish Government on policies such as minimum pricing, while at the same time vociferously disagreeing on issues such as pensions. Bennie hopes this upfront and honest working relationship will continue.

“I think one of the strengths that we have in BMA Scotland is that government politicians know that we will give them our clear and honest opinion in all matters. And we are not going to agree on everything, of course we are not. If there are issues on which we agree then we will be supportive and helpful. And if there are issues on which we don’t agree then we will make our voices heard.”

Bennie trained at Glasgow University Medical School, before going on to work as a junior doctor across the West of Scotland, and then as a consultant in General Adult Psychiatry in first Glasgow, and now Paisley. His association with the BMA also began back in his medical student days, he recalls.

“There were some junior doctor posts in Glasgow which were to be closed down, even though medical students had been appointed to them. Being a medical student myself at the time I thought that was wrong. To start with it was pretty much a one man campaign even to persuade the BMA junior doctors in the area that there was any problem with this. But it eventually was successful in getting that reversed,” he says.

“Right then and there I got a sense of the importance of having good representation from a Trade Union. And the BMA as you know, amongst other things, is a strong doctors’ trade union,” he said.

During his 30 years with the organisation, Bennie has chaired the BMA junior doctors committee in the UK and in Scotland, and the BMA representative body. He was also closely involved in negotiating the 2003 consultant contract in Scotland, is a member of the BMA UK council, and was appointed a BMA vice president in 2012.

However, as he begins his tenure as chair of BMA Scotland, it is the issue of junior doctors that he finds himself returning to as one of his early priorities for action.

In particular, Bennie says that across the UK the BMA has “significant concerns” about the ‘Shape of Training’ report, an independent review that looked at potential reforms to the structure of postgraduate medical education and training across the UK.

“One of our main concerns at present is that it feels a little as if this is just rolling along to implementation as if it is an uncontroversial idea. In actual fact we have real concerns that unless significant changes are made to these proposals for future training of junior doctors there will be two major knock on effects at either end of the training spectrum.“

The first, he says, is the basic concept that we will train more people as generalists than as specialists.

“At the end of training the basic concept within the report is we will train people more as generalists than as specialists. Now, that in itself is not necessarily the wrong way to do things. There is a real need for training more generalists, both for staffing hospitals properly, but particularly in Scotland for the remote and rural agenda. However, this report proposes that you will train generalists in less time than it currently takes to train specialists. And that is not logical at all.”

He continues:

“To have proper generalist skills you are likely to need more training, actually, than a specialist in order to be at the same kind of level of expertise. So at that end of the training spectrum, the end product, our real concern, unless there are changes made, is that the consultants and GPs who will come off the end of this training scheme as proposed will be significantly less skilled and less able to provide good quality patient care than the current training schemes produce.”

The second concern relates to the other end of training, he says, and a proposal to move the point where you become fully registered as a doctor to the day you graduate from medical school, as opposed to following one year of training as a doctor.

“We very strongly feel that that first year when you are very closely supervised and if you are not viewed as being satisfactory in your performance and your training you cannot then register as a doctor and work independently as a doctor. That has always seemed to us to be an extremely important safeguard for the general public.”

As well as the issue of patient safety, Bennie argues that this will also have an “inevitable” knock-on effect on competition for securing employment as a doctor.

“In this new system a substantial proportion will not actually move on to work as a doctor at all, will come out of medical school with debts in the tens of thousands of pounds with no realistic way of paying them because they are not employed as doctors. And the knock on effect from that we feel certain will be a reverse in what has been the increasing diversity of background of people going into medical school. And we think that is wrong. We think the doctors who are looking after society should, as much as possible, reflect the make-up of that society.”

While he says there will be some “uncertainty” on either side of the referendum, whatever the result, he assures that this is an issue they will be raising the Scottish Government as soon as possible.

“I suspect that whether we get a yes or a no there will continue to be steps that could be taken in Scotland to change the worst aspects of this proposed training scheme. We won’t know for sure until we sit down for negotiations with government once the dust has settled from the result. But we will certainly be taking this position to them in a very clear fashion very soon after the result.”