The British Medical Association prides itself on its supposed commitment to tackling societal inequalities, particularly inequalities in health. One of the key drivers of health inequalities is income inequalities. In a letter published in the BMJ by one of the BMA's staff, the BMA claimed that it pays all its staff well above the minimum wage. However, it did not state what staff whose services were contracted out - such as catering staff - were paid. What the BMA representative seemed to be saying in her letter was that the BMA had subcontracted the employment of workers who are most likely to receive the minimum wage to external companies and had no idea (and perhaps doesn't care?) what they are paid. In a follow on letter also published in the BMJ, I asked for further clarification from the BMA on this point. Nearly three months after publication of my letter, there has been no further response from the BMA. Does the BMA really care about inequalities - or are its comments on inequalities just a smokescreen to divert attention to what many people think is its primary purpose, negotiating pay deals for doctors?
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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