terms and conditions of service are negotiated directly with the central Health Departments. Who, then. will be the responsible employer? Doctors might well find themselves as a minority in a recognized employees' "agency" or union within a bargaining unit. Such a situation may already be imminent within the Medical Research Council. Doctors could then be involved in industrial action, decided legally by majority vote, contrary to their professional code. This would be a cruel dilemma and one not necessarily confined to the N.H.S.: universities and local authorities are other examples. On these grounds the inclusion of the medical profession in the provisions of the Industrial Relations Bill seems wrong. The question is: Should doctors seek exclusion, with the associated restraints on collective action, or accept inclusion, on the same terms as any other worker, and accept the dangers? A third way would be to press for recognition as a special group of "professional worker." Such a group would be recognized as having a prior obligation to a third partythe patient-but even this would not obviate the grave constitutional difficulties which the B.M.A. would face in becoming a recognized bargaining agent, an inevitable course if the profession is included within the Act in any way. It would necessitate either the dissolution of the B.M.A. and its re-establishment as a trade union or, alternatively, the setting up of a union in parallel with but separate from the Association. Though the drafting of the bill is said to be too far advanced for many of the points which the profession would wish to raise to be taken into account, nevertheless it seems that the Government in discussions with the B.M.A. has promised to consider amendments in Parliament. This offers some reassurance, but does not lessen the impression that the Government has hastened on with its main purpose of regularizing industrial relations without giving any thought to the serious consequences the legislation could have on other sections of the community for which it is wholly inappropriate. Sir Keith Joseph has a responsibility to the health professions to see that their special problems are properly presented to the Government. Unfortunately the Government's reaction to the recent report of the Monopolies Commission4 on restrictive practices in the professions shows an alarming ignorance of what a learned, liberal profession is and what it needs to sustain it. Professions are often an inconvenience to Governments because they will not change their principles and codes of conduct to suit passing political or administrative conveniences. To do so would be to abrogate their responsibilities to those they serve. But Governments must make up their minds whether they want professional men or technical experts to staff the N.H.S. Doctors for their part must choose whether they will accept the role of medical technocrats increasingly being thrust upon them or defend their traditional role as members of an independent profession practising complex skills. Amid all the current confusion of policy and purpose in Government intent, the principle at stake for the professions is their independence. This is not just an empty phrase or an exclusive privilege for the practitioner. It is a precious community asset. Doctors must stand up and be counted in its defence, for if they do not the patient will be the loser. If medical men are to participate in any way in the new industrial relations machinery, and this seems inevitable, they must do so fully aware of the dangers and mindful of their unique professional responsibilities. 1 British Medical Journal Supplement, 1948, 2, 7. 2 British Medical Journal Supplement, 1970, 3, 41. 3Department of Employment and Productivity, Industrial Relations Bill, Consultative Document, London, H.M.S.O., 1970. 4The Monopolies Commission, Report, Parts 1 and 2, Cmnd. 4463. London, H.M.S.O., 1970.
