BMA's response

By raising important issues about representation and accountability in the BMA earlier this year, Nizam Mamode has done the BMA a service. Any member organisation representing an important professional grouping ought to be able to show that it is fully responsive to the needs and concerns of members whenever it is challenged, especially from within.

Compensation for loss of earnings

Mr Mamode's first criticism is of the practice of reimbursing members of the BMA Council for demonstrable monetary loss while on association business. As he acknowledges, he has benefited from this arrangement, receiving a payment of £21 900 in 2000. Although he was compensated for losing part of his NHS salary, the BMA's practice has been to compensate members for monetary loss, whether it is from NHS or private practice. The BMA could stop compensation for losses from private practice while continuing to reimburse other sorts of loss, but this would unfairly discriminate against some members, particularly those who work exclusively in the private sector.

It is right that we should consider how, or indeed whether, to reward people for time spent working for their representative association. I have benefited from the BMA's compensation scheme but accept that there are powerful arguments in favour of remunerating doctors for what they do for the association, rather than compensating them for lost earnings.

Every member of the BMA receives a copy of our annual report and accounts, which not only refers explicitly to the compensation committee and its role but also lists by name the recipients of both compensation payments and honoraria.¹ I therefore do not accept accusations of secrecy.

This is proper disclosure, in full compliance with best practice, of the arrangements whereby council members have been remunerated for BMA work. If giving members this information provokes debate, I welcome it because that is the purpose of disclosure. Just such a debate took place at the BMA's annual representative meeting at the end of June. In rejecting the proposition that compensation for lost income (whether or not linked to private practice) should be abandoned, the meeting declined to share Mr Mamode's view. BMA Council will revisit this difficult and contentious issue in October.

Representation and racism

Next Mr Mamode argues that the BMA fails members by not representing them adequately. It is true that, although membership numbers are at an all time high, member engagement is not all we would wish. Like many other democratically based institutions, we are trying to find ways to involve members more fully in our work. I would be glad to hear fresh ideas from Mr Mamode or from any other member on how to tackle the difficult challenge of apathy and lack of engagement.

Perhaps the most serious charge is that of institutional racism. As evidence for this, Mr Mamode points to the litigation against the BMA by ethnic minority members who have claimed for racial discrimination, in particular the widely reported case of Mr Chaudhary. I do not for a moment underestimate the seriousness of this case and its impact both on Mr Chaudhary and on our reputation among ethnic minority doctors.

Two things need to be said about it. Firstly, the BMA, on the strong advice of leading counsel, is appealing the decision to the Court of Appeal. (It had been given permission to appeal from the Employment Appeal Tribunal). Secondly, Mr Chaudhary's substantive case of discrimination against the secretary of state for health was rejected by an employment tribunal in April this year. Funding for this unsuccessful case was, incidentally, provided by the BMA and represents a small part of a total of over £225 000 that the organisation has expended on legal fees for the various discrimination cases which Mr Chaudhary has conducted against NHS defendants.

Figure 1.

This year's annual representative meeting

Credit: BMA NEWS REVIEW

If the courts do uphold Mr Chaudhary's claim against the BMA, it would not automatically follow that the BMA is or was institutionally racist. Since the events that led to Mr Chaudhary's case, and the others often linked to it, we have transformed the way in which we offer advice to our members on racial discrimination. All such cases are evaluated by an outside law firm at the BMA's expense, and decisions about which cases to take up are made on their objective (but not, of course, infallible) professional judgment. This new system was put in place in October 2003—well before Mr Mamode raised his concerns earlier this year—and our members' experience of it has been extremely positive. Since then 47 discrimination cases have been accepted and taken forward on behalf of members. Fourteen of them have been successful and have led to members receiving appreciable awards for damages.

Should we lower the threshold for taking up discrimination cases below the 51% chance of success that is applied to all other tribunal cases? This is a difficult issue, but that threshold does not seem unfairly high. Members may seek legal support from the BMA for a huge variety of reasons, and in some cases their livelihood is at stake. We must ensure that we deploy our funds fairly and effectively. We need a sensible filter to ensure that we do not pursue cases that have little prospect of success, whether the grievance stems from alleged discrimination or another cause. Equally, we need to scrutinise the problems that doctors bring to us to ensure that we are always alive to the possibility that race discrimination may lie at the heart of the difficulty the member has experienced.

As to collective support for ethnic minority doctors, one of the key priorities that I have set for the association next year is the negotiation of a new contract for staff and associated specialists, a segment of the profession in which these doctors are over-represented. We do need to work harder to reflect the interests and concerns of all our members, particularly those from ethnic minorities who are inadequately represented in the BMA's inner councils. A new team now leads our equal opportunities committee: Sam Everington and Aneez Esmail have an unrivalled track record in identifying and confronting discrimination in the NHS. They are the best guarantee that diversity issues—the theme of the recent annual representative meeting in Llandudno—will remain high on the BMA's agenda. It is Mr Mamode's BMA just as much as it is mine, and we need people of his talent and energy not just to tell us where he thinks things are going wrong but to help us put them right.