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1. My campaign to achieve ‘Parity for related staff with unrelated staff’

   I am a mature student, at present attending the Yale interdisciplinary bioethics summer program. In my ‘policy and bioethics’ seminar yesterday Lori Bruce introduced us to the Kingdon Framework to bring about change. My campaign had fitted the model exactly: problem; solution; momentum. For years people have said I should write my story. Well, today’s session really got me fired up to put pen to paper.
   Nearly 30 years ago when my husband finished his GP training and was looking for a practice partnership. He was approached by the local councillors who were campaigning for a GP in a rural area of over 25000 population with no doctors’ surgery. Our two boys were very little and all the jobs seemed to be in inner city areas. I did not want to bring up my boys in congested and polluted cities. I liked living where we were, just on the outskirts of the English Lake District and on the Irish coast. So we decided to take the plunge and set up the practice on Walney Island, Cumbria. As there were no patients there was also no income. The National Health Service (NHS) has a capitation payment system for GPs. There is also reimbursement for staff and premises costs but until a GP has a list size of 1000 patients they didn’t get reimbursed. My husband could not afford any staff. Consequently, I entered the NHS by default. I was the receptionist, the practice manager and the cleaner. Building up the practice from scratch, we were motivated to put in best practice processes and systems in place, which later on won us Beacon Awards for Innovation and Best Practice. The patient list size grew rapidly as the need was great. In less than six months we had more than a 1000 patients. My husband was eligible to claim staff reimbursement so he employed a receptionist, practice nurse and I was the practice manager. When I put in the first staff salary claim for reimbursement to the health authority. To my amazement and horror, the claim for my salary was rejected for the sole reason that I was married to my GP employer. I was indignant, I appealed on the grounds that I had the necessary qualifications that they had seen my recent record of building up the practice from scratch. In fact, I had liaised with them continuously during this time. In addition to that, I had also enrolled on a business administration diploma at the college of further education. The response from the health authority was that their hands were tied as the legislation clause 52.2 of the Red Book (the GP payment regulation) prohibited reimbursement for related staff. I was appalled with this unjust ruling. I became adamant to pursue the cause to get justice so decided to go to the top. I sent an open letter in a medical newspaper to the then Prime Minister Mrs Margaret Thatcher. This was the beginning of our movement. There were lots of related staff – husbands, wives, sons and daughters up and down the country working for whom, their related GP employer was having to pay out of their own pocket. These GPs were being penalised for employing their relatives. Some GPs did not get married so as not to forfeit the reimbursement.
   I was very young then but I had the conviction of my principle. I knew this was unjust and something needed to be done. There were others around the country also fighting their lone battles. We decided to come together to form the ‘Doctors’ Wives Association’ with the objective to achieve ‘Parity for related staff with unrelated staff’. A formal organisation needed a constitution. To be honest, until then I had never read a constitution let alone written one for a ‘pressure group’. I went to the local library and got a book out on how to write a constitution. I sat at my kitchen table with my type writer many a nights writing the constitution. Within a few weeks, we had a formal organisation and there were over 150 members at our first meeting. The phone never stopped ringing. We became front page news of all the medical newspapers and then local and national newspapers. Some with quite sensational headlines such as ‘Wages for Sin’ as one of the members said to a newspaper reporter that GPs are cohabiting rather than getting married to avoid losing reimbursement. A reporter even asked me whether I would chain myself to Westminster Bridge adjacent to the Houses of Parliament in London to promote our cause. We continued to face challenges but we were determined. We were all approaching our Member of Parliament (MP) in our constituencies. I wrote to all the party leaders. We got the opposition parties on our side. However, it was my MP Mr Cecil Frank who I was able to convince, raised the question in Parliament. It was also raised in the House of Lords by Lord Winstanley. It became a standing joke at home, if the phone rang late in the evening that it would be an MP or a Lord ringing me. I also wrote to the then Health Minister Mr Kenneth Clarke who indicated that he would consider changing this ruling at the time of the new GP Contract which was imminent. We kept the momentum and even threatened to take our case to the European Court of Human Rights. The news of our campaign reached Europe and the Italian doctors’ wives association invited me to speak at their annual conference. Following that, I was invited to speak at the World doctors’ conference at The Hague.
   Finally, at long last, after six years of campaigning Mr Kenneth Clarke kept his word and with the revised 1990 GP Contract, the ruling was changed and we achieved Parity.
   The Italian, French and Belgian doctors’ wives associations wanted to form a European Doctors’ Wives Association as we had all formed great allegiance with each other but the British were not interested. I suppose we had run out of steam. We disbanded the association and donated any remaining funds to the British Medical Association Benevolent Fund.
   Our campaign has all the ingredients of the Kingdon Model. We had the problem of unfairness and unjust law; our solution was to ask for what was our right and we sure did keep the momentum going till we succeeded. Thank you Lori. How after all these years the bioethics program at Yale has provided the critical thinking for me to apply it to my story and has motivated me to share with bioethics friends.

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