An outline history of the British Medical Association
The British Medical Association (BMA) was founded by Sir Charles Hastings (1794-1866) at a meeting in the Board Room of Worcester Infirmary on 19th July 1832. 50 doctors were present to hear Hastings propose the inauguration of an Association both friendly and scientific.
Called the Provincial Medical and Surgical Association (PMSA) until 1856, the Association's objectives were to promote the medical and allied sciences and to maintain the honour and interests of the medical profession - aims which remain the same today. The Association was registered as a company limited by guarantee in 1874 and became listed as a Trade Union under the Trade Union and Labour Relations Act 1974.
The nineteenth century
Almost immediately after its foundation the Association became involved in the struggle for medical reform. The BMA Medical Reform Committee after 20 years of negotiation successfully secured the passing of the 1858 Medical Act. The Act established the General Medical Council and the Medical Register, therefore distinguishing, for the first time, between the qualified and unqualified practitioners.
Important amendment acts were later passed including the Medical Act of 1886, after which it became mandatory for all practitioners to qualify in medicine, surgery and midwifery rather than on any one of these areas. The 1886 Act also enabled the profession to directly elect representatives onto the Council.
Other issues of particular importance at this time were the operation of the 1834 Poor Law Act and its effects on both the poor and the medical profession, the notification of infectious diseases and collective investigations. One of the most active and influential of the Association's bodies was the Parliamentary Bills Committee. First appointed in 1863, from 1872 to 1897 the Committee was under the chairmanship of Ernest Hart, at that time also Editor of the BMJ.
The Committee took a leading role in influencing legislation on public health matters including (as well as those already mentioned) the registration of midwives, the exposure of "quack medicine", the treatment of inebriates, mental health legislation, housing and factory legislation, coroner's law and death certification, and the regulation of baby farming.
Branches and divisions
The first Branch of the Association was the Eastern Medical Association formed in September 1835 and which amalgamated fully with the Provincial Medical and Surgical Association two years later. Branches were established by members of the PMSA in their own locality in order to fulfill more effectively the several purposes for which the Provincial Association was formed.
The first Scottish Branch was the Edinburgh Branch founded in 1875 closely followed by the Glasgow and West of Scotland Branch a year later. The first Welsh Branch was the Monmouthshire Branch of 1852 and the first Irish Branch was the South of Ireland Branch of 1874. The first overseas branch was established in Jamaica in 1877. In 1903 following a reorganisation of the BMA's constitution a further unit, the division, was established below the branches. In 1973/74, following another reorganisation, the Branches were abolished and replaced by Regional Councils.
The early twentieth century
The National Health Insurance Bill introduced by Lloyd George in May 1911 introduced a new field of medico-political action to the BMA. For a maximum contribution of fourpence a week, every employed person in the country could be insured against sickness. The BMA while supporting the principle behind the Bill objected on several grounds.
The first and probably the most important was that the medical benefits of the Bill were to be administered by the friendly societies, the trade unions, and the insurance companies. Doctors were given no say in how the service was administered. Overall, the BMA objected to the lack of consultation with the profession when the Bill was in its planning stages.
At a BMA Special Representative Meeting in June 1911, the Association formulated its famous "Six Cardinal Points" which included; an income limit of £2 a week to join the scheme, free choice of doctor by patient, that payment to the doctor should be adequate, and that there should be adequate medical representation among the various administrative bodies working the Act.
By 1913, despite the BMA's opposition, doctors were signing up to be part of the scheme in large numbers and although the BMA had not been completely successful, in the final Act four of the BMA's six cardinal points had been fully or partial met. The Westminister Gazette at the time remarked we all admire people who don't know when they are beaten. The trouble with the BMA is that it doesn't know when it has won.
War
For the duration of the First World War from August 1914 in Scotland, and January 1915, in England and Wales the BMA's Scottish War Emergency Committee and Central Medical War Committee (CMWC) played crucial roles. An Irish committee was established in May 1915. The BMA was responsible for organising the demand for doctors to the armed forces while also maintaining a full medical service for civilians.
Again in 1939, at the request of the BMA, the medical profession was entrusted by the Government with the responsibility for recruiting its own members for military service and for ensuring that in each area sufficient numbers were deployed between the armed forces and the civilian medical service. The machinery responsible for this was again the Central Medical War Committee.
Other issues which concerned the Association in the first half of the twentieth century included the production and marketing of "secret remedies", nutrition, physical fitness, the relation of alcohol to road accidents, and the medical aspects of abortion.
The birth of the NHS
By 1930 the BMA itself had produced its own plans for a "general medical service for the nation". In 1938 these were reissued to incorporate recent BMA policy on hospitals and maternity services. In 1940 the Association set up the Medical Planning Commission charged with considering the future of the British medical services. The Commission's report was published in June 1942.
Later in the same year, in December, the Beveridge Report was published, announcing that a comprehensive national health service...for every citizen would be established. The Report's scheme was to insure the whole nation against unemployment, illness, injury, and retirement, the funding for this to be achieved through contributions from individual citizens, employers, and the Government. The White Paper "A National Health Service" was published on 17 February 1944.
The BMA (the Secretary was at this time Dr Charles Hill) agreed in principle with the establishment of a comprehensive medical service, as its work before and during the War shows. However, as with the National Health Insurance Act the BMA objected to the administration and the lack of negotiation and consultation of the proposed Act with its subsequent effects on the livelihood of practitioners.
In 1945 a Negotiating Committee was set up of whose members the majority were appointed by the BMA. Under its Chairman, Dr Guy Dain, the Committee negotiated with the coalition Government. After the 1945 General Election the Committee had to contend with a new Minister of Health Aneurin Bevan.
On 15 December 1945 the Negotiating Committee announced "7 principles" to which the proposed service would have to adhere if it were to gain professional support. These were: no salaried service, clinical freedom, free choice of doctor for patients, free choice for doctors of form and place of work, freedom of every registered practitioner to join the public service, a hospital service centred on universities, and adequate professional representation on all administrative bodies.
The National Health Services Bill was published on 20 March 1946 and became law on 6th November 1946. The BMA distributed a referendum to all members of the profession asking whether discussions should commence on the regulations authorised by the National Health Services Act and three plebiscites were held.
After the third plebiscite the BMA held a Special Representative Meeting at which the Council recommended that the profession co-operate in the new health service. The BMA had obtained several important concessions from the Government, which had been compelled to accept an Amending Act before the main Act came into force.
Finally, the National Health Service came into operation on 5 July 1948. Subsequent disputes followed, in particular the Danckwerts remuneration award. After the NHS was created the BMA now stood alone as the profession's representative body. During the NHS negotiations the BMA had been only one party among several in discussions with the Government.
Later issues
The fifties and sixties saw the BMA concerned with a number of moral issues. They submitted evidence to the 1951 Royal Commission on Marriage and Divorce. A few years later in 1955, the BMA reported to the Wolfenden Committee into the law relating to homosexual offences and prostitution. Getting Married, 1959 published by Family Doctor, a popular health magazine produced by the BMA contained an article, "Is Chastity Outmoded? Outdated? Out?" which produced a stream of criticism from both doctors and the public alike.
Three enquiries, which culminated in the 1960s had important implications for general practice. The first of these was the Royal (Pilkington) Commission on Doctors' and Dentists' Remuneration, appointed in 1957. The second inquiry was the Medical Services Review Committee, a review internal to the profession.
This Committee's report, known as the Porritt report, was published in 1962 and included important recommendations for reforming NHS administration, particularly for the formation of areas health boards. The third committee on general practice was set up in 1961 under Annis Gillie and was charged with examining the future of general practice. Its report was published in 1963. 1965 saw the publication of the BMA's General Medical Services Committee paper A Charter for the Family Doctor Service.
In 1968 the Government published Green Papers on the administrative structure of the National Health Service in England and Wales and in Scotland which proposed unification under area boards. 1971 saw the publication of the BMA's Memorandum on Association Policy in Relation to Smoking. In 1972 the Chambers Report was published. Commissioned by the BMA, this was a wide ranging review of the Association's constitution and organisation. In 1975 Lord Goodman produced comprehensive proposals to settle the pay-beds issue.
In response to the perceived threat of nuclear war in the early 1980s, the Association reported on the possible medical and environmental effects of global conflict. The BMA’s first statements on AIDS in 1985 followed the world-wide spread of the disease. In 1992, the genetic engineering working party culminated in the publication, “Our Genetic Future”, which considered the scientific and ethical implications of genetic engineering.
By the late 1980s, market forces had entered the NHS. The BMA contested the internal market, and, in the following decades, opposed foundation hospitals on the grounds of potential inequality. Contract negotiations have challenged the BMA in recent years. Now in the first decade of a new century, the BMA faces many more challenges: the impact of European Union directives on the profession; devolution in the UK; new technological sources for medical advice; and a review of the representative structure and governance of the Association itself.
Published histories of the BMA and BMJ
- History of the British Medical Association 1832-1932, E Muirhead Little, BMA, 1932
- History of the British Medical Association Volume II 1932-1981, E Grey-Turner & F M Sutherland, BMA, 1982
- Doctors' Commons, A Short History of the British Medical Association, P Vaughan, Heinemann, 1959
- Themselves Writ Large, The British Medical Association 1832-1966, P Bartrip, BMJ, 1996
- BMA House, A Guide, J Smith, BMJ, 1982, 1988
- Promoting the Medical and Allied Sciences... A short history of science at the BMA, E Naish, Chameleon Press Ltd, 1995Mirror of Medicine, A History of the BMJ, P Bartrip, Clarendon Press & BMJ, 1990
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