BMA needs a richer way to encourage participation

BMJ 1995; 311 doi: (Published 08 July 1995) Cite this as: BMJ 1995;311:82

Much of the buzz at the BMA's annual representative meeting comes from the press. The press desks under the main platform are usually a hive of activity. Journalists scribble furiously, adjust their tape recorders, and troop in and out to hear medicopoliticians speak. And usually there is a row of television cameras, but this year there are none.

This year the ARM has had to compete for media attention with the twin attractions of a minor British film star arrested in Los Angeles for lewd behaviour and a tense election in the Conservative party for a new prime minister. Unfortunately, on the first day at least the ARM lost, and by the end of the afternoon the press benches were almost empty. But it wasn't only the missing press --and a large hall which felt empty--that gave the meeting a flat feel.

True, the chairman of council, Sandy Macara, delivered his opening speech (see p130) with his usual force and clarity and received a standing ovation. He celebrated the BMA's defeat of local pay bargaining, but Dr Macara's main emphasis was on the continuing message on the need to reform the reforms. The final point in his seven point plan for this re-reformation is the encouragement of cooperation, not competition, and there's some pleasure that the Labour party at least has picked up that theme in its own document on health policy (see also pp 75, 79, and 1 July, p13).

But the chairman's speech apart, many of the debates, covered familiar ground and reached conclusions that haven't changed much from last year--or, indeed, the year before. Counted votes suggested that at any one time barely half the representatives were present in the conference. Both contributed to the feeling, widely commented on by many representatives, that the debates were flat and uninspiring.

The meeting may well liven up: the GPs will debate their frustrations over out of hours arrangements, the scientific debates are always interesting, and there are new issues. But the underlying problem remains: the issues have probably outgrown the format's ability to handle them. Six hundred motions are listed for debate over four days, with most speakers confined to two minute slots. The subjects range from housekeeping measures within the BMA to the key medicopolitical issues facing doctors. Many of the motions are never debated, and any that are seem to be let down by ill prepared or absent speakers; many of the arguments are never heard because speakers don't get called or because the debate is curtailed. None of these criticisms is new. What is striking this year at Harrogate is the many representatives who openly commented on the event's lack of steam. Many similar professional organisations both in Britain and abroad have changed the format of their annual conferences. The Australian Medical Association and the Royal College of Nursing, for example, have meetings that allow for extended discussions on important issues. They build on policy work that has gone on during the year and use it to have well informed debates. Indeed, the BMA's own academic and consultants' conferences have moved in this direction.

The BMA has always been fiercely proud of its democracy, offering through divisions (and now through local negotiating committees), regional committees, the craft committees and conferences, and the ARM itself multiple opportunities for doctors to participate. Rightly, none of the elected officers wants to lose that ability to participate. But it may be that rethinking the ARM would allow richer ways of tapping that willingness to participate--and not leave so many empty seats.--JANE SMITH, BMJ

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