It is possible to envisage several ways in which left-wing doctors may organise themselves. They could establish a caucus within the main medical association, like the Democratic List in the West German medical elections. They could establish a left- inclined professional society, as in the case of the Medical Reform Society of Australia. They could, like the Socialist Doctors’ Association in Norway, unite in an explicitly socialist doctors’ organisation linked with a socialist political party.

They could create a series of single-issue pressure groups. They could support each other in groups established on the model pioneered by the women’s movement. Or they could form a trade union. It is possible to observe the elements of each of these models of organisation in Britain today, and to trace their history.

The British medical left has never had a dominant group amongst its organisations, but two organisations come to the fore as having had significant influence over a prolonged period of time – the Socialist Medical Association (SMA) and the Medical Practitioners’ Union (MPU). The SMA has probably been the main organisation of the left in medicine for most of its history, but in the last ten years it has ceased to be a predominantly medical organisation, a fact reflected in its recent change of name to the Socialist Health Association. As a result the mantle of the labour movement’s medical organisation has passed to the MPU which, since 1970, has been part of ASTMS and therefore part of a trade union affiliated to the Labour Party. For most of its history the MPU would have played down its political role and claimed simply to be a trade union. Today it would accept the role of being an organisation of the left in medicine, although with the proviso that in medical politics ‘left’ starts somewhere right of centre on the broader political spectrum. (For example, Dr David Owen of the SDP retained his membership of the MPU after leaving the Labour Party, and is still a member of the union.) Similarly the MPU would today place less emphasis on being a trade union. It is a trade union, would not deny that, and wants to remain as such. However it would recognise the legitimacy of other models of organisation of the medical left, and would seek (so far with only limited success) to accommodate those different models within a single structure. It would therefore see itself as well placed to be the dominant standard bearer of progressive doctors, although its acceptance as such is far from universal.

The first dilemma that faces the medical left is whether it is to address itself primarily to the profession or to the outside world. Is it to put its energies into campaigning in medical politics and changing the ideas of the profession, or is it to be a medical support group for the Labour Party, trade unions and other progressive groups, or is it to concentrate rather on providing psychological support to its own members in their daily practice? The six different models that I have discussed reflect different emphases amongst these three objectives.

The second dilemma is the conflict between organising the medical left and organising progressive forces in medicine. Left-wing doctors are a minority. They are a minority not only because the profession is right-wing, but also because it is depoliticised, and since depoliticisation is the root of the problem it is not sufficient simply to redefine ‘left’ so that it includes Social Democrats, Liberals and members of the Tory Reform Group.

The most powerful progressive force in medicine actually comes from the progressive elements of medical ideology. Caring, humane doctors committed to the National Health Service, but denying the political correlates of those attitudes, are much more common than those who would describe themselves in political terms, but such doctors are difficult to mobilise for an organisation which defines itself politically.

The other major potential progressive force consists of those groups who are badly treated by the medical status system, such as black doctors, women doctors or doctors in low-status specialties. These doctors have an interest in challenging the power structure of the profession.

Is it possible then to unite these three forces – the left in medicine, the neglected groups in medicine and those doctors who are professionally committed to a progressive view of health and health care but do not define this commitment in political terms?

The six models of organisation which I have discussed approach this problem differently.

The Founding of the Medical Practitioners’ Union

The Medical Practitioners’ Union was founded in 1914 as the Medicopolitical Union, later changing its name to the Panel Medical Practitioners’ Union, adopting its present name in 1922. It became a section of ASTMS in 1970.

The records of its first decade are lost. (Subsequent records are kept in the Modern Records Centre at the University of Warwick.)  By 1925 it was a well established organisation mainly composed of doctors working in the National Health Insurance Scheme. At this time its records speak of regular communication with Local Medical Committees (LMCs, the statutory bodies which represent all GPs) and it organised its own conferences of LMCs in advance of the official conference. Some LMCs contributed to an MPU-run defence fund, again clearly rivalling the defence fund run by the Insurance Acts Committee of the BMA/ Executive Committee of the Conference of LMCs.

In its evidence to the Royal Commission on National Health Insurance in 1925 the MPU described itself in these terms: ‘The MPU … represents the more progressive opinion of all sections of the profession, and in particular perhaps of those who have watched with no little anxiety the increasing complexity of the relations between the state and the medical profession.’

The evidence went on to advocate a state medical service, controlled by local authorities, financed from the National Exchequer and organised on a regional basis. However it opposed a salaried service and was equivocal about including specialist service in the scheme because it seemed to think that specialist service could be provided by finding specialist expertise within the ranks of general practice.

The main campaigning issue during the late 1920s was the question of disciplinary procedures for doctors. The MPU was concerned at unfairness in the way that the Minister of Health, after investigation by special bodies, was able to withhold sums from a GP’s remuneration as a punishment for breach of the NHI conditions of service.

In the Council meeting on 12 November 1925 we find discussion of a letter from a doctor in Stockton on Tees advocating the publication of a list of specialists willing to advise members of ‘approved societies’ (the basic unit of National Health Insurance) at a one guinea fee. At the same meeting we find a grant of £300 to Dr Gregg (a Council member who was later to chair the BMA Insurance Acts Committee/Executive Committee of the Conference of Local Medical Committees) for nursing a constituency, and the renting of a room in the basement to the secretary so that he could have a vote in Holborn. At the Council meeting of 10 December 1925 we find a telegram sent to the King and Queen expressing sympathy at the death of Queen Alexandra. The union was one of the contributors to a medical scholarship at Epsom College, and we find regular references in the minutes to the union’s vote in the election of the scholar. The practice appears to have been to vote for the son of one of the union’s members. This support for a public school is rather out of keeping for a TUC-affiliated union.

The flavour of the 1920s continued into the 1930s and in the close relationship between the MPU and the LMC/Insurance Acts Committee structure was confirmed in 1937 by the election of a member of MPU Council to the chairmanship of the Insurance Acts Committee. Complaints emerged at this time that the MPU had become ‘part of the establishment’.

The First Rift

In the 1940s we find these complaints dispelled by the rift between the MPU and the BMA. Through the 1930s there was no evidence of sharp differences of opinion between the MPU and the BMA over the issue of the National Health Service. At this time both organisations favoured the development of national health insurance so as to create a

comprehensive state medical service. The BMA was unremittingly hostile to the idea of full-time salaried service, whilst the MPU was more equivocal but still did not share the SMA view that this was a fundamental issue. The MPU shared the SMA view that finance from the national Exchequer was desirable, whereas the BMA was more equivocal on the ques­tion of the mode of finance.

In the late 1930s we find a good reaction to an MPU document on a state medical service, with large numbers of copies being ordered by the governments of the Dominions.

In the 1940s the BMA began to draw back from the con­sensus of the 1930s, so that local-government control, which the BMA itself advocated in 1930, became a bogey to resist at all costs, and the actual proposals for a National Health Service were bitterly opposed, admittedly on detail, but on so many details and in such vehement tones that the impression was clearly established that the BMA opposed the NHS.

The MPU allied itself with the SMA on this issue, suppressing its earlier doubts about full-time salaried service to the point where in 1941 the MPU and SMA took part in a joint delegation to ministers to press for such a service.

In March 1944 the MPU criticised the White Paper for not giving enough attention to health centres and for allowing too much private practice. It commented: ‘Practitioners should submit to such control as the expenditure of public money and the administrative needs of the service would necessarily entail.’

The MPU’s decision to ally itself with the SMA rather than the BMA during this conflict marked the end of an era and a considerable change of tone. There appears to have been an estrangement from Dr Gregg, not obvious in MPU records but referred to in BMA records many years later. The correspond­ence from LMCs, their donations to the National Practitioners’ Protection Fund and their participation in MPU conferences all end in the 1940s. From that point on the MPU is in opposition.

The MPU and the Whitley Council

After the battle over the NHS had passed, the MPU became involved in a battle for representation on the Doctors’ and Dentists’ Whitley Council. Whitley Councils were in the process of being set up as the forum for negotiating the pay and conditions of NHS staff. The BMA claimed all the staff side seats on the Doctor’s and Dentists’ Whitley Council on the grounds that it represented over 75 per cent of doctors. However the MPU also claimed seats, as did three other unions with medical members – the Association of Scientific Workers (J.D. Bernal’s union, later to merge with ASSET to form ASTMS), NALGO and COHSE. NALGO and the AScW appear to have based their claims on very small numbers indeed, but COHSE had enough medical members to organise a Medical Workers’ Guild and the MPU and COHSE established a joint committee.

The battle was finally settled by a repetition of the formula by which the BMA had resolved the conflict over whether it or the LMCs represented GPs. The BMA had established a committee, the Insurance Acts Committee, which was set up under the by-laws of the BMA but was composed mainly of representatives of LMCs, who need not be BMA members. This committee was then accepted by resolution of the Conference of LMCs as its Executive. It could then be recognised by government as the undisputed representative of GPs, without settling the issue of whether it was so recognised because it was the appropriate BMA committee or because it was the Executive of the Conference of LMCs.

The BMA repeated this procedure, setting up through its by-laws three committees (for GPs, for hospital doctors and for public health) elected by universal franchise of all doctors, whether or not members of the BMA, in the relevant sector. These committees were then recognised as ‘representatives of the profession’, without specifying whether this was because they were BMA committees or because of their universal franchise. This arrangement persists to this day, although the committee for hospital doctors has been split into separate committees for junior doctors and for consultants.

The MPU was given two seats on the General Medical Services Committee, the successor of the Insurance Acts Committee. In return it agreed not to make direct representations to the Ministry of Health concerning pay and conditions of GPs. The MPU was not given seats on the other committees, where its membership amongst the relevant sector of the profession was much smaller. Paradoxically this has left it in a stronger position in the hospital service and community medicine, for it has still been able to gain an input into the offical machinery by winning seats in the electoral process, whilst not being precluded from putting its own point of view directly to the Minister or to the Review Body.

After the MPU had reached its agreement with the BMA, accepted the new machinery and its seats on the GMSC, and withdrawn its claim for direct representation on the Whitley Council, COHSE, NALGO and the AScW were left out in the cold. There are no further references to the MPU/COHSE Joint Committee and the COHSE Medical Workers’ Guild has faded away, although COHSE still has a few doctors in its membership.

Rise and Fall in the 1960s

The 1950s were a quiet period for the MPU, and its minutes suggest that it was in the doldrums and merely responding to events. Two significant points stand out, however, which prefigure the turbulent 1960s. One was a growing concern about the politicisation of the union. The other was the major organising campaign run by Laurie Pavitt in the late 1950s. This campaign laid down the organisational network that was to allow the union to tap the discontent in general practice during the 1960s.

Before the war, general practice had been the mainstay of the profession, and most specialists outside London, Glasgow and Edinburgh were GPs with a special interest which led to their being consulted by colleagues. There was no sharp distinction between general and specialist practice. After the war, general practice became subordinated to and separated from the hospital service. The GP was the doctor who had fallen off the Hospital career ladder.

This led to demands for improvements in the status and the quality of general practice.

In taking up these demands the MPU tapped a combination of economic interest and idealistic commitment to the service on the part of a neglected group of the profession. In the early 1960s the MPU expressed these feelings in a Family Doctor Charter and began to mobilise doctors around it. A series of mass meetings were held in various parts of the country. The union’s membership increased dramatically and ultimately the leadership of the GMSC were obliged to accept the MPU ideas and negotiate them with the government. On 9 May 1965 Dr Cameron, the Chairman of the GMSC, visited a meeting of MPU Council to bring the union a detailed confidential account of the progress of negotiations.

However at the same time that the union was riding high with the charter the issue of politicisation was creating a split in the union. Allegations of Communist infiltration of the union were made in 1964 in a letter to the British Medical Journal and at the same time the rumbling discontent about links with the Labour Party erupted.

In December 1964 there was an election for President which Terry Gardiner won by nineteen votes to five over a Dr Craig. At the Council meeting on 10 January 1965 it was reported that Drs W.K. Davidson, A.A. Brown, W.M. Wilson, Bruce Cardew and D. Cook had resigned from Council and the MPU. Two other Council members, including Dr Craig, were reported in The Times as resigning but did not in fact do so.

The internal dispute was complex. On the one hand the politicisation of the union was at issue, so that the conflict was between the Labour-inclined doctors who had dominated the union since its schism with the BMA and a more depoliticised membership, including the idealistic GPs who had been drawn into the union as a result of Laurie Pavitt’s organising campaign. However the Communist smear frightened Labour Party members as well. Lord Taylor, a junior minister in the Labour government, told the MPU Planning Committee of 3 February 1965 that he was under pressure from his superiors to resign, and Dickson Mabon did resign, later to rejoin. Bruce Cardew, a former General Secretary and Labour candidate was one of the five council resignations.

The union seemed to ride the storm. A committee of enquiry was set up and reported that there had been no infiltration by ‘any political party’. Membership rose instead of dropping.

But this was an illusion. The union ought to have recruited large numbers of members as a result of the Charter, but in fact the number of new members from the Charter was reduced by the schism, while the full impact of resignations resulting from the split was delayed by the Charter’s success. Once the Charter issue died down there was a haemorrhage of members. The union ceased to be viable as an independent entity and in 1970 merged with ASTMS on remarkably advantageous terms, which guaranteed it full autonomy on medical matters and allowed it to send two non-voting observers to meetings of the ASTMS National Executive.

The schism may also have affected the union’s effectiveness in the growing militancy of the junior hospital doctors. The MPU began organising junior hospital doctors in the late 1950s. By the late 1960s there was a growing militancy about their neglect by the BMA which the MPU should have been well placed to take up. The MPU, however, failed to capture this militancy which went instead into the Junior Hospital Doctors’ Association.

TheJHDA

The JHDA was founded in 1966. The late 1950s and early 1960s had seen a career-structure crisis with many Senior Registrars failing to find consultant posts, many of them being forced to emigrate in order to practise the specialty to which they had committed their careers. This led many junior hospital doctors to question the long hours and insecure career prospects on which the junior grades of the hospital service were based.

The JHDA articulated the demand for a balanced career structure, properly organised training programmes, job security, shorter hours and better working conditions. By the late 1960s it had gained control of the representative machinery of junior hospital doctors – then the Hospital Junior Staffs Group Council, a sub-committee of the CCHMS.

Having taken over the HJSGC, the JHDA discovered that all progress on the major issues was blocked by the consultant majority on the parent committee. The HJSGC therefore embarked on a campaign to gain autonomous status in its own right. The JHDA fought this campaign with considerable flair. There were pictures of the chairman of the HJSGC being carried bodily out of a BMA committee room after attempting to attend a meeting of craft committee chairmen. At the same time the JHDA was publicising the problems of junior doctors by demonstrations, lobbies and publications. It played a major part in the campaign for reform of the General Medical Council and was successful in winning seats at the elections in 1971.

For all its flair, its 5,000 members and its dominance of the official machinery, the JHDA was able to make little progress against a rigid BMA hierarchy. The JHDA therefore adjourned the Hospital Junior Staffs Group Council sine die and sought independent negotiating rights for itself. The BMA reconvened the Group Council and, ironically, gave it autonomous status as the HJSGC a few years later. The JHDA never gained negotiating rights, but continued to be a major threat to the BMA through the early and mid-1970s. Decline set in towards the end of the 1970s, to the point where the organisation, renamed the Hospital Doctors’ Association, became a mere shadow of its former self with little real influence and only a handful of activists.

From the inception of the JHDA the MPU was anxious to merge with it, and serious merger discussions took place in the early 1970s after the MPU merger with ASTMS. These discussions failed and merger was not to take place in the JHDA’s heyday. (An agreement to merge the HDA with the MPU was eventually signed in mid-1986 and then repudiated by the HDA within a few months).

In the early 1970s the MPU was an unsuccessful and dying organisation. The merger with ASTMS did not halt the decline in membership and an expensive recruitment campaign on traditional ASTMS lines failed. There was some militant activity amongst junior hospital doctors, but merely a pale imitation of the JHDA. Accordingly the JHDA saw little reason to give up its independence.

Revival of the MPU in the 1970s

The only bright spot for the MPU was the revival of the Manchester branch in 1972 under the leadership of Judith Gray. Judith – who died tragically young in 1985 – was an idealistic and vigorous community physician with a great capacity to inspire people. (Judith Gray’s tragically early death in 1985 occurred between the writing of the second and third drafts of this book. The tributes paid to her here were written while she was still alive and without any expectation of her death. More than 200 people attended her funeral.) As a result of her activities the MPU’s Manchester branch grew and became a focus for a new set of ideas about how the MPU ought to function. These ideas in turn inspired other people and led to a considerable development of the MPU through the late 1970s and the early 1980s. During that time a succession of new groups were formed in various parts of the country, until by mid-1984 the MPU was able to repeat the boast that Laurie Pavitt had made in 1959 at the end of his organising campaign: ‘there is an organisation in most parts of the country.’

The key to this growth had been the coincidence of three themes – bringing the left in medicine together, defending the NHS and articulating the grievances of neglected groups in the profession.

First of all, however, the MPU was to play an important role in creating proper trade union structures for the medical profession.

The 1975 junior doctors’ dispute brought the MPU to prominence. ASTMS was the first organisation to make the dispute official and the MPU played an important part in the dispute in many areas.(This dispute is described by S. Iliffe and H. Gordon, Pickets in White, London 1976.)

More important however was what followed the dispute. The settlement that had been reached was open to many different interpretations and therefore heavily dependent on local negotiation. The BMA was not equipped for such negotiation. ASTMS was, and the MPU made considerable impact in taking up local issues in those areas where it was well organised.

The MPU came out of the dispute with a significant hospital doctor membership in London, in the North-West of England and in the West Midlands. There were also general practice members, left over from the Charter, in most parts of the country, and most particularly in South Wales.

In the three areas where the MPU had established a hospital membership it was able to involve itself in local negotiations. I will describe the North West as an example, since it was the area in which I was personally active and can write from personal experience. The situation in the other three areas, however, was similar.

The North West Health Region consisted in 1975 of eighteen health districts (it now consists of nineteen) and the MPU dominated the representation of junior hospital doctors in four of those – Blackburn, Bolton, Trafford and Wigan. It vied with the BMA for dominance of three others – South, Central and North Manchester – and had scattered members in the other districts, with representatives accredited to thirteen of the eighteen districts.

In Trafford the union established excellent negotiating relationships with the Area Medical Officer which allowed the grievances of junior doctors to be processed rapidly and fairly.

Managements in other districts were less sensible. In Blackburn the new contracts of junior hospital doctors were negotiated by an ASTMS full-time official and the consultants then intervened to press the district to renege on the agreement. Difficult negotiations then took place which seriously soured relationships between junior doctors and consultants, but the union finally won its case at a health authority dispute panel, mainly because intemperate attacks on the union by the consultant representative created sympathy for the union position.

In Bolton the union came to the verge of industrial action when the authority withdrew study leave for a number of our members because of difficulties in finding locums. I was called in to assist the local rep and when it became clear that the authority could not be budged I set out to explore the possibility of our members simply taking their leave anyway (management can only manage if it is obeyed). I discussed with other ASTMS members in the hospital what they would do if an MPU member was disciplined for following our advice to proceed with the study leave, and I received assurances that any restrictions we might impose would be recognised. I then told the authority that our members declined to recognise the cancellation of their leave and would be going off on leave as if it had not been cancelled. A meeting was then set up to discuss the matter. When the MPU member present said that our members would be taking their leave whatever the authority said, the management response was to threaten dismissal. At that point the MPU rep paused, leaned back in his chair and very quietly asked, ‘How do you propose to run an orthopaedic department without X-rays?’ Management conceded the case immediately.

At Wigan management were just as authoritarian but rather more stupid. Their tactic was not to concede anything to the union until it had worked for it. Perfectly straightforward applications were turned down repeatedly and conceded virtually at the door of the dispute panel. The union representative was a surgical Registrar whose career suffered a serious setback as a result of victimisation following his union activities at Wigan. The management attitude boosted union recruitment and finally led to dispute.

The Wigan Dispute

It is worth describing the Wigan dispute in detail since it is the only occasion that doctors have taken strike action over a local issue and the only occasion where a medical dispute was won mainly because of solidarity from other health workers.

There was a curtain raiser to the main dispute a few weeks previously. The health authority planned not to employ a locum for an absent doctor at Leigh Infirmary but, instead, shift all the work to Wigan’s main hospital. This would have resulted in a considerable increase in work for the doctors at the main hospital without any extra pay. The MPU requested support from other unions. This was forthcoming. ASTMS presented a claim for an extra technician to cope with the extra pathology work at the main hospital together with compensation for lost work for the technician at Leigh. NUPE asked for extra pay for porters at the main hospital for the added workload. The suggestion was made that if all the union claims were not met ambulancemen might refuse to move patients. The management backed down.

Meanwhile there continued to be grumbling disputes about payment o£ doctors for covering absent colleagues. At one point the health authority tried to pay doctors for this work at the ordinary rate of 30 per cent instead of the 100 per cent locum rate. Many claims were simply unpaid. In one case a doctor who did an out-patient clinic for a colleague in the afternoon and then did his usual afternoon’s work in the evening was told that he could not be paid because the afternoon work had been within his contracted hours and the evening work had been his ordinary work.

The issue which finally precipitated the dispute concerned a doctor who agreed to give up his holiday if he was paid for doing his own locum. When he received his salary he had only been paid for the basic week and not for overtime. When he protested the employers said that they had no power to pay him for doing his own locum, so he would have to repay the money they had given him and take his holiday. It was by now impossible for him to take his holiday before finishing his job, so they undertook to give him a letter to take to his new employer asking for him to be given the lost holiday.

The cynicism of this response was the last straw. Wigan MPU members met on the Monday and gave notice that as of Friday they could withdraw all covering of colleagues unless the various outstanding claims for locum payments were met, and procedures laid down to prevent a recurrence of the situation. The MPU decision was supported by all of the junior doctors at the hospital. The immediate crisis for the hospital was that there would be no Resident Surgical Officer that weekend.

On Tuesday the ASTMS Divisional Officer attempted to contact the employer to negotiate. He was told ‘the MPU are holding a pistol to our heads’ and ‘we can’t play this kind of brinkmanship’. He was told that on Wednesday he would be contacted and told whether or not the employer was prepared to negotiate. On Wednesday lunchtime he was told that a meeting discussing whether or not to negotiate had been under way for two and a half hours and was not completed. He therefore used the ASTMS emergency procedures to have the dispute declared official.

Meanwhile the MPU had been obtaining the support of other health workers. When management said that they would break the action by bringing in local GPs as strike-breakers, they discovered that the Local Medical Committee had advised GPs not to accept such work, and that the Joint Shop Stewards’ Committee had told its members not to work with strike-breaking doctors. Porters would not move patients for them, switchboard would not bleep them and technicians would not accept their instructions.

Management held firm until a few minutes before the dispute was due to start, and then agreed to talk. The union had to decide whether to suspend the action for the duration of the negotiations. They decided not to do so, and the action was put into effect, but steps were taken to see that there were enough doctors around to deal with genuine emergencies. These doctors were off duty, but, of course, no doctor would withhold services from a patient in need. If anything had happened which required a surgeon, those surgeons who happened to be around would have dealt with it just as a doctor would deal with a patient who collapsed in front of him whilst he was out shopping.

(This was neither the first nor the last occasion on which use was made of this technique for protecting patients whilst officially not providing cover. In the 1975 junior doctors’ dispute the MPU recommended that any closed Casualty Department should be picketed, so that a doctor would be available if a dying patient turned up. Other organisations ridiculed the advice. However it is notable that the press attributed one death to the 1975 dispute, that of a small child who died in the ambulance after being taken past a closed Casualty Department. If this death was indeed avoidable, it would have been avoided if the MPU advice on picketing had been followed. The protective picket concept was certainly applied by the GPs who closed their health centres on the health workers’ days of action in 1982. The health centres concerned with picketed by the doctors and any patient who needed immediate treatment received it from the pickets.) Industrial action lasted less than two hours. Negotiations took place in front of an audience comprising all the junior medical staff, and all demands were conceded.

BMA Response to MPU Competition

This period in which the MPU was a major industrial relations competitor to the BMA was, however, to be a passing phase. ASTMS successes such as that at Wigan were patchy. The MPU had started the 1975 dispute with a very small and scattered membership. In those areas where there was a base to build on, the dispute enabled the MPU to recruit, especially after the prompt action of ASTMS in making the action official. Where such recruitment took place the MPU was well placed to move on to the creation of local organisations when the dispute was over. Over most of the country, however, the MPU had barely existed before the dispute, was not able to exploit it, and was not therefore well placed to develop local organisation after the return to work.

In some areas doctors turned to the MPU after experiencing appalling service from the BMA. One such example was Lanarkshire where the majority of doctors in a particular Mess left the BMA and joined the MPU after the BMA had failed to help them with some local problems, and they had turned in desperation to ASTMS, who had handled the matter competently.

On the whole, however, the BMA service was not bad enough to bring about this outcome, mainly because of the tireless work of Camille Haughten and Joan Sharp in the HJSC office in Birmingham. Junior doctors soon learned to ring Birmingham instead of their local BMA office. These two officers struggled to maintain a service to the whole country and succeeded mainly because of their tenacious loyalty to their members. Had it not been for them ASTMS would have driven large swathes through the BMA junior doctor membership in the two or three years after the dispute. ASTMS was at that time a lot better than the BMA in the local service it offered. But because of these two women the BMA service was not quite bad enough to break doctors’ traditional loyalties and lead them to try something new.

The BMA rewarded Camille and Joan by transferring the HJSC office from Birmingham to London, where it could keep an eye on it, and making them redundant. For the second time in a decade the BMA had survived the strong chance of a split in the profession – this time by the loyalty, ability and dedication of two members of staff whom it neither deserved nor appreciated.

The BMA regained the initiative by setting up its own system of Industrial Relations Officers, many of them recruited from trade union backgrounds, to provide the service of local negotiation. There is no doubt that this was a direct response to the ASTMS threat, and to that extent the MPU can take credit for it.

Recent Consolidation of the MPU

After this brief interlude of acting as a serious rival to the BMA, the MPU returned to its more traditional role. The theme of defending the NHS has been the main recruiting theme, along with appeals to neglected groups. In the late 1970s considerable effort was put into the problems of women doctors and in the early 1980s a campaign was launched against racism in medicine. Specific neglected groups, including community-health doctors and associate specialists, were championed.

In 1979 the union launched a campaign to reduce the hours of work of junior hospital doctors and this campaign, which included the promotion of two parliamentary Bills to limit by law the hours worked, was so successful in gaining support that the HJSC was forced to respond by launching its own hours of work campaign in 1980. The HJSC campaign has made some progress, but the MPU is planning a revival of its own campaign.

In 1982 the union started work on a new General Practice Charter, intended to emphasise the planning of general practice to meet the needs of the community. A discussion document was produced, followed by a conference in November 1983. A year later in November 1984 the union held a conference on community care.

In 1984 the union decided to develop work along the theme of poverty and health, including the holding of a professional seminar to draw themes out of the literature for political use.

The MPU today is an organisation with a wide range of activities and a firm base, mainly composed of left-wing doctors. Its leadership is politically-oriented but recognises the need to broaden the union’s base.

The Council’s report to the 1984 MPU AGM states:

Our members are predominantly drawn from the ranks of doctors who recognise the political connotations of defending health and health care. However the constituency whose interests and values we represent is much broader than that. There are many thousands of doctors who are committed to the promotion of health as a social value, and to the creation of an improved health service, operating on a team basis, devoted to prevention, rehabilitation and care as well as cure, and planned to meet the needs of the communities it serves and to whom it should be accountable. However many of those doctors see such a commitment as professional rather than political and feel some unease at recognising as their champion an organisation which is also, unashamedly, the medical organisation of the labour movement. In the medical profession, left starts somewhere right of centre, and depoliticisation is so widespread that progressive ideas may exist in isolation from their political correlates. This situation has provided barriers to the recruitment of a large proportiqp of our natural constituents, and must be understood if our base is to be broadened.

The MPU has recently begun to make some progress in recruiting doctors who are progressive rather than left-wing, and in recruiting doctors from neglected groups. The parallel with the growth of the union in the late 1950s comes to mind. Can the MPU repeat the process and if so will it face the same problems?

There is one major difference. Instead of broadening its base by denying the importance of the political views of the leadership, the MPU now accepts the role of the medical organisation of the labour movement, and seeks to accommodate other strands of thought as well, on the basis that it takes many strands to form the pattern on a carpet.

Whether this will work remains to be seen. It may set up added difficulties which will prevent the repetition of the successes of the 1960s. But if it does succeed it should prevent the kind of events that occurred with the schism of the mid-1960s. People who have entered into an honest alliance do not have the scope to say, legitimately, that they were enticed into an organisation with a hidden agenda. Indeed their response to the accusation that their organisation contains politically oriented people is likely to be, ‘So – what else is new?’

However a warning must be sounded. Twice in its history the MPU has gone through a cycle in which left-wing doctors build an organisation, the attractiveness and idealism of which led to a massive increase in membership, and then conflicts between the old left-wing leadership and the new less political recruits led to a destructive split. It is now well into the third repetition. The question is whether it will learn from history or repeat it.

The MPU and the TUC

The union affiliated to the TUC quite early in its history but the relationship has never been a good one. The possibility that the union should disaffiliate from the TUC in protest at its anti-medical stance recurs in its minutes. The first reference to a proposal for disaffiliation appears in 1937. This proposal rumbles on for 30 years and on 21 May 1967 was defeated by only ten votes to eight with two abstentions, after a Council debate which Vic Feather attended to defend the TUC. This issue disappears after the merger with ASTMS, and indeed special terms were negotiated at the time of the merger to allow the MPU to retain a separate affiliation from ASTMS. The undertakings given by the TUC in 1970 were unilaterally abrogated in 1983 when a right-wing campaign to take over the TUC depended on removing 200,000 left-wing votes from the small unions section of the General Council elections by disaffiliating two sections of the TGWU. The MPU was the innocent victim of a change of rule to prevent sections of unions affiliating separately from the parent union. Throughout the discussion of this rule change issues of principle and fair dealing were subordinated to sordid vote grubbing, and in its 1983 Annual Report the MPU commented, ‘The movement has lost more than we have.’ Despite decades of dissatisfaction the MPU still remains part of the TUG as a section of ASTMS and therefore part of the ASTMS affiliation. It is ironic that it should in 1983 have fought hard, and unsuccessfully, to retain a separate affiliation when historically it had attached little value to that affiliation and had repeatedly debated terminating it.

The MPU has long seen it as part of its role to provide medical support to the trade union movement. Issues of industrial health begin to appear in its minutes in the 1930s. In 1959 the General Secretary wrote to 40 large unions offering medical help. Today the MPU operates a system of ‘medical safety representatives’, effectively a panel of medical advisers to trade union safety reps. In 1983 it organised a conference to explore the role of trade unions in health promotion.

There are certain other TUC-affiliated unions which have medical members. The Institution of Professional Civil Ser­vants represents doctors in the civil service and the Association of University Teachers has a position amongst doctors employed in universities, but this has been heavily eroded in the last few years by BMA competition. The Merchant Navy and Airline Officers Association represents ships’ doctors. COHSE had traditionally sought to recruit doctors, and still has a small medical membership, and there are a few doctors in other health service unions. There may also be some industrial doctors in membership of industrial unions.

The only other specifically medical union within the TUG is the Hospital Consultants and Specialists Association. This organisation existed for many years as the Regional Hospital Consultants and Specialists Association, a rather insignificant professional society. During the mid-1970s it grew into a major threat to the BMA. The mythology of BMA House has  it that this growth was stimulated by two delegates to an ARM who behaved quite unreasonably at a compositing meeting, failed to get what they wanted, and then took their bat home. The HCSA certainly tapped a genuine political force – consultants who felt threatened by the way in which changes in the profession were removing their influence and power. It appealed most strongly to consultants who had graduated in the 1950s, too early to benefit from improvements in the conditions of junior doctors and too late to experience the wealth and prestige for which they thought they were making sacrifices. This cohort of doctors felt very bitter at frustrated expectations. The HCSA articulated their feelings. In the mid-1970s it grew rapidly to threaten the BMA but then declined as the BMA began to recover its old style. It remains, however, a voice against dilution of the consultant concept, articulating a genuine strand of opinion, and, by its existence, imposing constraints upon the BMA. Given its reactionary nature it is surprising that it should affiliate to the TUG, and equally surprising that it should form a loose federation with the JHDA. Both were pursued with the idea of gaining negotiating rights, but have failed. The federation is now virtually defunct, and the TUG affiliation is used mainly to gain publicity of the ’embattled doctors struggle against overwhelming odds’ type.

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