Interview: 100 years at the heart of GP politics

As the Medical Practitioners' Union celebrates its centenary, Dr Ron Singer tells Neil Roberts why it remains an 'influential ideas factory'.

Amid this year's commemorations of 1914, a group of GPs are marking their own centenary.

The founding of the Medical Practitioners' Union (MPU) 100 years ago was shaped by the tumultuous political period at the start of the First World War, says its president, retired London GP Dr Ron Singer.

Launched as the Medico-Political Union to represent doctors working for the new national insurance system and in response to dissatisfaction with the BMA, the MPU developed as a trade union champion of a national health service, and part of the wider labour movement.

Dr Singer, MPU leader since 2002 and one of its GPC representatives from 1996 until earlier this year, says he joined the union at a time of political tumult and radicalisation.

Inspired as a medical student by industrial and political militancy around the world in the late 1960s, Dr Singer said the MPU appealed to him above the established BMA.

At a time when workers across the NHS were taking action, Dr Singer says, the BMA was campaigning for consultants' right to take on private patients. The views of many doctors at that time, he says, were 'to put it bluntly, unacceptable'.

Cajoling, pressuring

Over the years, the MPU has been, although a small union of several hundred members, an influential 'ideas factory', says Dr Singer, 'cajoling and pressuring' other organisations.

The union developed the GP Charter in 1964 in response to workforce problems. Adopted by the BMA a year later and by the NHS in 1966, it helped to address the crisis of the day and lay the foundations for modern, quality general practice.

In the 1980s MPU junior doctors led the campaign against the 120-hour week, camping on the street outside a London hospital. The union can also take credit for the development of GP commissioning, says Dr Singer, which evolved from its locality commissioning ideas.

Campaigning

In recent years, the MPU has successfully campaigned for better health services for asylum seekers and detainees and is at the forefront of the Save Our Surgeries campaign in east London, fighting to protect practices hit by funding cuts.

'The lesson MPU is able to bring to the profession,' says Dr Singer, 'is that you have to be on the streets. You have to bring your colleagues to a point where they can see that unless they act collectively and in a fairly visible manner, the plight of general practice will not be recognised.'

The MPU has had two reserved seats on the GPC since 1966, when the union surrendered its national contract negotiating rights. But MPU doctors, many of whom are also BMA members, maintain the need for a separate organisation.

The MPU's ideology, says Dr Singer, is that doctors should organise as part of the wider workers' movement and society, not in isolation.

The MPU has long been part of a larger union and is currently part of Unite, a union affiliated to the Labour party and the TUC, whose members include 100,000 health workers.

Defending salaried GPs has long been an MPU campaign priority. Too often, salaried GPs are treated as second-class doctors, says Dr Singer. The union promotes a model of principal salaried GPs with equal responsibilities to independent contractor colleagues.

A vertical integration model of GP consultants salaried to trusts is the 'only way forward', Dr Singer believes. GPs would no longer be subject to contract imposition and would have defined roles.

'The model is that GPs in an area get together and say, we wish to enter a dialogue with our trust about becoming a part of the trust, and we want to lead the changes that have to take place in the NHS,' he explains.

Real concerns over the loss of independence from such a move are not insurmountable, he says, especially with strong union organisation. 'I think the profession has to give it serious thought. At the moment it is being hammered.'

He adds: 'My experience on the GPC is that independent contractor status disempowers GPs. The GPC does a very good job for the profession, so far as it possibly can, but when push comes to shove, the government imposes changes.'

GPs today, says Dr Singer, are in the position of teachers several years ago. 'Deprofessionalisation' is leading to doctors being treated like other public sector workers, with cuts to pay and conditions.

'To fight effectively, you have to be a member of a trade union that can take industrial action, that sees this as a legitimate thing to do, even though you're a doctor,' Dr Singer says.

MPU GPs are discussing plans to push the GPC to ballot the profession to take industrial action over the funding threat to practices.

'The government sees no contradiction in saying doctors can't go on strike because of looking after patients, but is quite happy to cut their fundamental pay. It can't have it both ways.'

The union is considering changing its name to coincide with the achievement of its centenary.

Current favourite, Dr Singer says, is Unite Doctors.

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