Only days into his job, and Dr Peter Bennie is treading a political tightrope. As the newly appointed chairman of the British Medical Association in Scotland, he is the voice of Scottish doctors, and their fate is at stake in the referendum. But he has to be neutral. His association’s official policy is to stay clear of stating its position. “It’s a very sensitive time just now,” he admits.
That does not, however, prevent Dr Bennie, a psychiatrist based in Paisley, from taking on the argument, and it is quite clear that he would like to say more. He holds strong views; he may be the only BMA chairman to have gone on strike. In 2012 he took part in industrial action in protest at the UK government’s failure to honour a pension deal negotiated by doctors, and though he lost the argument, he still feels it was the right thing to do.
“Yes, I was very much at the forefront of industrial action,” he says. “The BMA’s ethos is about negotiation, but the UK government took the decision that they were requiring more money to cover the deficit, and they were going to take it from our pensions. It was in my view, and the BMA’s view, unprincipled, but they did it anyway.”
Although it was a Westminster decision, he was not greatly impressed by the way the SNP government handled it. They caved into pressure and were forced to implement the changes.
“It’s all water under the bridge, but we were uncomfortable with that formula. It smacks a little of not taking responsibility in Scotland,” he said.
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His greatest concern about the outcome of the referendum is how a future Scottish government would deal with training the next generation of doctors. He is deeply alarmed by the Greenaway report Shape of Training which, in his view, introduces a market-led approach that will make it more difficult for poorer students to access training.
“This is going to do significant damage to the training of junior doctors, and therefore GPs throughout the UK,” he says. “We’re having significant difficulties at the UK level in getting our message across.”
He would like a future Scottish government to take a stand against it, because it recommends that doctors be trained as generalists rather than specialists, cutting back on training time. “There’s an underlying idea within the report that it takes a shorter time to train a generalist than it does to train a specialist,” he said. “In actual fact, it’s the other way round — at least it is, if your intention is to train a generalist to the same level of expertise and quality as the current consultants and GPs are. If it’s not altered, it will deliver significantly less experienced and trained doctors than we have at present.”
But he also detects a business approach which sits uneasily with the BMA’s idea of a state-led health service.
“Some of it is looking to an idea of introducing market forces into medical training,” he said. “There is a potential message underneath which says, let’s train more medical students than you need and there will be a proportion that will not progress. The argument against is that there’s an increasingly heavy financial burden to go into medical school at all — the course is longer, fees higher, so there’s a bias against those from more diverse backgrounds, and those who do not have independent means from their parents.
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“If you then introduce a system where the likelihood of future employment as a doctor is significantly reduced, then the real risk is that you are reducing further the diversity of those who are going into medical school. We’ve always felt at the BMA that actually it’s important you are working in the opposite direction.”
Not surprisingly, perhaps, he is convinced that the Scottish approach to the NHS has, since devolution, been superior to the English system, where privatisation has been allowed to play a role.
“There is no doubt that the Scottish health service is closer to the overall BMA policy,” he said. “Legislation from the first SNP government made it illegal for a private company to take over a general practice. Yet that was effectively becoming UK policy south of the border. The BMA across the UK feels that the model adopted in Scotland is more appropriate.”
So is it frustrating that he cannot reveal whether the BMA supports independence or not?
“We have to be in a position to negotiate with all parties, whatever the outcome after September 18,” he says. “And for that reason it would be wrong for us to take a position either way, so it’s partly about reflecting the views of our members, and partly about being in a position to negotiate.”
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The BMA in Scotland is not taking sides in the independence debate, but has set out ten key questions it would want a future Scottish government to address:
· With an ageing population, how will you ensure that decisions are taken in order to ensure sustainable healthcare for this and future generations?
· Can you confirm that you are committed to free healthcare at the point of delivery, and explain how you see this being funded in the context of economic constraint?
· What more can be done to attract doctors to live and work in Scotland?
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· How can we ensure that Scotland remains a world leader in the provision of high quality medical training?
· What can be done to improve the work/life balance for health professionals in the NHS?
· In recent years doctors have seen unwanted changes made to their pay and conditions, how will these types of changes be determined in the future and what might they look like?
· What can be done to address the social determinants that drive health inequalities and Scotland’s reputation as “sick man of Europe”?
· Scotland has a strong track record for introducing world-leading public health policies. Can you assure us that measures to improve public health will be maintained?
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· How can it be ensured that Scotland retains its reputation for excellence in the field of medical research?
· What assurances can be given that access to medical school will remain through academic merit and not ability to pay?