A return to the tribe that wears white

Thoughts about the focus for my weekly blogs come from many sources. Top of the list will be things I have read, followed in no particular order by things I might have heard, seen or experienced. I often hear something that piques my interest on the Radio. Radio 4 is my favourite station. The variety of programmes means there is always something interesting to listen to, as I drive. Last week, driving home, I listened to the Radio 4’s PM programme. One of the reports was a follow up to an interview the day before with Melissa Ryan. She is one of the co-chairs of the resident doctors’ committee.

Resident doctors were formally known as junior doctors. Last week they announced they would be taking five days of industrial action later in July. The threat of industrial action results from the government refusing to agree to the British Medical Association’s (BMA) demand for a further 29.2% pay rise. Resident doctors agreed a two year 22% pay uplift last year. This year they have been offered a further 5.4% pay award. However, the BMA argues that when inflation is factored in, doctors’ real-term pay has actually fallen since 2008.

The PM discussion explored measuring inflation. It was a discussion that took me back to my MBA studies when we were taught how to calculate the future value of money and those net present value calculations which we had to do for our capital business cases. Horrible!!!

There are two main ways of calculating inflation, the Retail Prices Index (RPI) and the Consumer Prices Index (CPI). In the UK, since 2008, the agreed gold standard for measuring the rate of inflation, is the CPI. The BMA have chosen to use the RPI. Now to demonstrate why these two different measures are important, I turn towards the independent health and social care ‘think tank’ - the Nuffield Institute - for help.

Comparing changes to pay over different points in time will sometimes give differing outcomes; so will using different measure of inflation. Absolutely so. The Nuffield Trust compared the impact on resident doctors pay since 2008 using both RPI and CPI measures. They have calculated that by the end of this financial year (2025-26), if RPI were used, doctors pay would have decreased by some 17.9%. However, using CPI as the measure over the same period would result in a fall of just 4.7% since 2008.

Now as regular readers of this blog know I try and avoid politics, so I don’t want to delve into the political consequences of untangling and resolving this situation. I am however, interested in the potential sociological consequences that are beginning to emerge. When I wrote my PhD thesis I drew amongst others, upon the work of Melvin Konnor, a brilliant anthropologist.  One of the books he published in 1993, was called The Trouble With Medicine. I urge you to try and get a copy to read, as it is remarkably prescient when thinking about today’s health care zeitgeist.

In the book, he, at one point, describes doctors as the Tribe that Wears White. It was an interesting idea, and reflected the often familial, but definite professional ties that bind doctors together as a single powerful profession. Allegedly, if you upset one doctor, you run the risk of upsetting them all. This hasn’t been my experience, but clearly there is a sense of loyalty to each other not seen in many other professions. We saw this loyalty in action during the previous 11 occasions that resident doctors took industrial action. Consultants and other senior doctors stepped into the gaps left by striking resident doctors. It felt like an act of beneficence that saw their junior doctors exercising their right to take industrial action while reducing the potential harm to patients. There are signs that the social cohesion evident across the medical profession is beginning to splinter.

Notably, the immensely popular professor, TV doctor and pioneer of IVF treatment, Lord Robert Winston, resigned from the BMA last week. He had been a member for 64 years. He noted that taking industrial action now ran the risk of damaging people’s trust in the profession. It was a view echoed by Lord Ara Darzi, who had recently undertaken a review of the state of the NHS. Recent polls suggest there is very little support from the public for further industrial action. Large numbers of people across England are struggling in so many ways. Often people’s lives are fragile and precarious. Lord Winston noted that: ‘strike action completely ignores the vulnerability of people in front of you’.

Melvin Konnor expanded his thinking about who has infiltrated the tribe that wore white, ‘the tribe under study is all of us; doctors, nurses, hospital managers, government representatives, bureaucrats, lawyers, and last but not least, patients, a position that sooner of later includes us all’. The governments recently published ’10 year Health Plan; Fit for the Future’ gives us all a chance to really change the way health care is provided in the UK – I hope we don’t blow this opportunity.