The British Medical Association (BMA) was founded in Worcester in July 1832 as the Provincial Medical and Surgical Association, a collective organisation for doctors. Established in the midst of a cholera outbreak, the association was initially established for the sharing of scientific and medical knowledge. However after re-branding themselves as the BMA its leading figures quickly began to involve themselves in “medical politics” – representing the profession’s views on healthcare and public policy to the governments of the day.
For instance, in 1838 the association was prominent in lobbying Whig prime minister Lord Melbourne over the implementation of the 1834 Poor Law. That year The Times (20 March 1838) reported Dr. George Webster, BMA President, decrying the poor law’s pay regulations as being as ‘insulting and degrading to the character of the medical profession as they were unjust and injurious to the poor’.
These sorts of interventions were always complicated for the BMA, involving a mixture of issues, including the duty of the profession to patients in general and the poor in particular, as well as doctors’ own direct financial self-interest. Such concepts were difficult to untangle and throughout its existence the association has struggled to reconcile representing both “medical opinion” on healthcare policy and defending doctors’ standard of living.
Over the course of the 19th and early 20th Century the BMA continued to expand, playing a key role in the 1858 Medical Act, which formally regulated for the first time who could legally practice medicine and established the General Medical Council. By the time the BMA opened its current headquarters at Tavistock Square, London, the BMA was the most authoritative voice of the medical profession. At that point (1925), the association concerned itself primarily with, in the words of prominent member Sir George Newman, the task of “securing improved public and personal health standards”, primarily through the extension of the panel system of health insurance instituted in the 1911 National Insurance Act.
In 1932 the BMA celebrated its 100th birthday with 100 branches, 250 divisions, and a membership of 35,000. By the 1930s, as historian John Stewart notes, its membership was largely dominated by general practitioners and other primary care providers, with their interests being those most directly reflected in association policy. Most GPs at this point worked in their own surgeries, usually in single-person practices purchased from more senior colleagues. Many doctors valued the independence these arrangements afforded them very highly, an attitude represented in the BMA’s steadfast opposition to the prospect of a salaried medical service run by local authorities (as advocated by the Labour Party and its affiliate body for clinicians, the Socialist Medical Association in the early 1940s).
This difference of opinion would become crucial after Labour’s landslide election victory in July 1945. With the new government determined to establish some kind of new national health service and the BMA stridently opposed to the idea of doctors being directly-employed by the state on set salaries, a very public row erupted between Minister of Health Aneurin Bevan and doctors’ leaders. In 1947, the BMA threatened to boycott the new service if their concerns about their independent status weren’t addressed. Eventually Bevan conceded the continuation of contractor status for doctors, retaining “capitation” – the arrangement whereby doctors were paid per registered patient.
In these negotiations the BMA’s collective bargaining tactics increasingly came to resemble those of a conventional trade union, a label that the association had usually resisted in the past. Considering the matter in 1914, the association declined to establish a fund for trade union purposes, on the grounds that it would prove ‘derogatory to its dignity’ (The Times, 27 July 1914). After the events of the early post-war period, the BMA again tried to step back into this previous role as a professional association for sharing medical knowledge and influencing public policy through lobbying. According to historian Kelly Loughlin, in the 1950s the BMA looked to modernise its public relations in the hope of focusing attention on its scientific discussions rather than medical politics or doctors’ working conditions.
For much of the post-war period the BMA was aided in avoiding the kind of confrontations found in many other British workplaces first by a relatively generous pay award in 1952 following a public inquiry, then by further awards by the Review Body on Doctors’ and Dentists’ Remuneration, set up in 1962 to ensure doctors’ pay and conditions remained fair. Nevertheless, from the mid-1960s onwards the association began to complain that doctors’ declining real wages were hurting the profession and forcing doctors overseas in order to make a good living. In their 1966 pay negotiations, the BMA even went as far as collecting undated resignation letters from 18,000 doctors, threatening to submit them if their pay claim wasn’t met.
In 1971, the BMA finally applied to be officially recognised as a trade union by the government, and in 1975 its members went on strike for the first time, with junior doctors fighting to maintain the extra pay they got for long hours. So forthright was the association’s pay demands that year that Barbara Castle, Minister for the Social Services in Harold Wilson’s Labour government, was moved to scold one negotiator that he was “just a middle-class miner” (The Times, 5 July 1982) – a reference to the miners union having won a huge pay rise after a militant strike the previous year. At this point, the BMA adopted other features of trade unionism, including hiring full-time industrial relations negotiators and inviting doctors to stand as “place of work representatives” (POWARS) – effectively a form of shop steward.
New ground was also broken in 1982 when the BMA was cautiously supportive of other striking colleagues – nurses and auxiliary workers – citing the NHS’ perilous finances as a reason for inter-occupational solidarity. Over the next two decades the BMA would continue to clash with Conservative and Labour governments, primarily over funding and the extent of privatisation and marketisation. In both 1990 and 2012 the association mounted considerable (but unsuccessful) campaigns in opposition to health service reforms. From the Autumn of 2015, the association has also been involved in a long-running battle against the imposition of a new junior doctors contract which proposed to change hours and working arrangements.
Today, the BMA’s 151,000 members are organised into 7 branches of practice: Consultants and specialists, general practitioners, junior doctors, academics, students, public health doctors, and non-consultant staff. It continues to juggle its difficult dual role representing both the collective interests of doctors as workers and publicising doctors’ views on medical matters.