This site uses cookies to bring you the best experience. Find out more
Skip to main content


Background of the CBS

The Confederation of British Surgery: A Trade Union for Surgeons Professor John Macfie Founding President

On 8th November 2017, the Certification Office approved the application to add the “Confederation of British Surgery” (CBS) to the UK’s list of recognized trade unions. For the first time there will be an organization, a trade union, recognized in UK law which is committed exclusively to surgeons and their related teams and families.

Some historical perspective may be useful. Since the publication of the History of Trade Unionism in 1894 by Sidney and Beatrice Webb, the predominant historical view is that a trade union "is a continuous association of wage earners for the purpose of maintaining or improving the conditions of their employment.” The origins of trade unions can be traced back to 18th century Britain, where the rapid expansion of industrial society then taking place, drew women, children, rural workers and immigrants into the work force in large numbers and in new roles.

Trade unionism in the United Kingdom was a major factor in some of the economic crises during the 1960's and the 1970's, culminating in the "Winter of Discontent" of late 1978 and early 1979, when a significant percentage of the nation's public sector workers went on strike. By this stage, some 12,000,000 workers in the United Kingdom were trade union members. However, the election of the Conservative Party led by Margaret Thatcher at the general election in May 1979 saw substantial trade union reform which saw the level of strikes fall. The level of trade union membership also fell sharply in the 1980's, and continued falling for most of the 1990's. The long decline of most of the industries in which manual trade unions were strong – e.g. steel, coal, printing,  docks – was one of the causes of this loss of trade union members. In 2011 there were 6,135,126 members in TUC-affiliated unions, down from a peak of 12,172,508 in 1980. Trade union density was 14.1% in the private sector and 56.5% in the public sector in 2011 (EuroFound, 2013). The density is defined as the proportion of paid workers who are union members.

I had always assumed that the trade unions were predominantly aimed at the “working classes” and was surprised to see that the highest membership/density is actually in professional occupations according to the statistical bulletin on Trade Union membership  published by the Department for Business Innovation And skills in 2014 where the density is around 30% for professional workers (almost 60% in female employees.)

Against this background perhaps we can see where the CBS sits. The declared aim of the CBS is to look after the professional and employment interests of surgeons and their teams irrespective of Surgical Royal College or Surgical Specialty Association affiliation.  As such, CBS would be able to involve itself in matters relating to terms and conditions of service, contracts of employment, litigation, insurance and other matters from which the Surgical Royal Colleges and the numerous Surgical Specialty Associations are excluded on the basis of their charitable status and the ‘public benefit’ concept which this entails.

The CBS is emphatically and specifically not in competition with the Surgical Royal Colleges or Surgical Specialty Associations, as these have remits relating to clinical standards, education and membership activities and are not permitted to act, in any way, as a trade union.

The vision that members of the Confederation will have access to appropriate cover and advice relevant to working in the unique and often stressful surgical environment is now being realised. The aim is to provide exclusive benefits to surgeons, extended members of the surgical team and their families. In protecting and supporting surgeons and their teams in the workplace, the ultimate aim is to improve the care of all patients requiring surgical care.

The creation and recognition of the CBS was a long time in gestation. The idea was first considered over 15 years ago. There has always been agreement that surgeons were poorly represented by existing trade unions but considerable debate took place concerning the best way forward. Discussions took place with both the BMA and HCSA in an attempt to establish some recognition of the particular needs of surgeons and survey work was carried out before embarking upon the road to recognition for a trade union specifically for surgeons. 

The process of recognition has necessitated extensive correspondence and frequent meetings with the Certification Office who have been most helpful. A “rule book” and a “strategy” document had to be provided, both of which are available to on the website.

The CBS now works closely with the Federation of Surgical Speciality Associations (FSSA) which was instrumental in achieving our development. The catalyst for the establishment of CBS arose following discussions within the FSSA. The FSSA is comprised of the Presidents of the 10 GMC recognized surgical associations including the BOA.  However, the FSSA does not exist as a body corporate in law and is not a charity in its’ own right (as are most of the Associations).  In many respects the activities of the FSSA in recent years represent the aspirations of the CBS.  

Examples include:

  • Dealing with surgeons in difficulty
  • Training surgeons of the future
  • Choosing wisely: cost effective surgery
  • Ensuring the future of surgery

All of these initiatives resulted in discussion documents that were published and were widely disseminated. They are seen to have been useful background for surgeons to discuss their own specific problems with local employees. CBS has co-opted as a member of its’ executive the President of the FSSA thereby maintaining close links.

Clearly, the ultimate objective of the CBS will be to negotiate on behalf of its surgeon members on matters specifically relating to their employment and terms and conditions of service. Issues of particular relevance to surgeons include:

  1. The split in the Consultant Contract between SPA (supporting professional activities) and DPAs (direct clinical care).  This varies greatly around the country.  Most surgeons are of the view that the allocation of 1SPA in a 10 PA contract for research, training, audit, revalidation is unacceptable. Surgeons and their clinical outcomes are now in the public domain.  It is critically important that facility is given to them to ensure published data is accurate. 
  2. A recognition of the onerous nature of on-call commitments for surgeons.  Surgeons work in high intensity environments.  This should be recognised. 
  3. Waiting list initiative payments: for some years governments have encouraged surgical activity outwith normal contracted hours in order to reduce waiting times.  These additional activities are paid over and above standard salary but the rates of pay vary widely up and down the country. This is unfair and should be standardised. 

There are inconsistencies in the means by which awards are made. This should be standardised.

It is relevant that none of the issues above are in the forefront of negotiations by the BMA, as surgeons are a small minority (less than 10%) of the total BMA membership.

It is neither feasible nor sensible for the CBS to attempt to embark simultaneously on all of these issues and we are now identifying priority issues and commence lobbying on behalf of surgeon members.  Such lobbying would include not only parliament but also existing trade unions such as the BMA and the HCSA.

CBS has developed and is pursuing the following negotiating aims on behalf of its members

  1. To impress on the HHS, Department of Health and Foundation Trusts the need for inclusion in collective, local and individual  bargaining on behalf of its membership.
  2. CBS recognizes that, to be effective, it will have to demonstrate a commitment to surgeon members and their employment concerns.
  3. To achieve effective, legitimate and effective representation of surgeons’ views CBS has developed an established media presence:
    •  Extensive use of social media.  Most surgeons are adept with modern technology and invariably possess smart phones, access to the internet and other forms of social media.  We have developed twitter feeds, WhatsApp facility and LinkedIn account on a regular day to facilitate the determination of those employment issues that cause most concern.  Use of social media permits large numbers of surgeons to express opinions in short periods of time.  Whilst CBS does not at present have formal national negotiating rights with employers this is a matter which we are seeking to address.
    • Many surgeons are familiar with dealing with the media.  CBS is using current contacts to facilitate dissemination of information and by so doing increasing the profile of surgeons in the UK as distinct to the BMA (which predominantly represents general practice) or HCSA (which has a small membership of unconnected consultant specialities but few surgeons).
    • The FSSA, with which CBS maintains a close working relationship, is very familiar with the use of “survey monkey” as a means of gauging opinion on various topics.  Surveys which are succinct and which address topical issues usually have a satisfactory response rate.  CBS has used “survey monkey” to assess the depth of feeling on a wide range of employment issues and is seeking to establish policy on behalf of surgeon members and then lobby on their behalf with issues such as parental leave, bullying and Harassment and Pensions.
    • CBS is establishing effective communications with all Trusts and other NHS employers in the devolved nations by inclusion of Senior Clinical Managers in the Executive Team.
    • CBS is establishing effective communications with all specialty associations via its membership of the FSSA and inclusion of a number of past SSA presidents in the executive team
  4.  Negotiation on behalf of individual surgeon members is now a reality and we are developing strategy to represent the views of the surgical community as a whole. At this stage we are seeking meetings with Parliamentarians and all other stakeholders to establish our presence and contribute constructively to the future of surgical practice in the UK
  5. References

"United Kingdom: Industrial relations profile". EUROPA. 15 April 2013.

Webb, Sidney; Webb, Beatrice (1920). History of Trade Unionism. Longmans and Co. London