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Background of the CBS

The Confederation of British Surgery: A Trade Union for Surgeons

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.

It is hoped and intended that members of the Confederation will have access to appropriate cover and advice relevant to working in the unique and often stressful surgical environment. The aim will be 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 has been a long time in gestation. The idea was first considered over 10 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 download (see links below.)

As part of the development strategy the intention is to lobby parliamentarians. There are currently two surgeons in the House of Lords who are sympathetic to the concept of a trade union specifically created for surgeons (Lords Kakkar and Ribeiro).  It is the intention of the CBS to arrange to meet their Lordships to discuss future direction and current policy.  This would also ensure that the Secretary of State for Health was informed of this development.


It is also intended that membership benefits will be offered by CBS:

  1. Medix insurance: This recently developed affinity scheme set up in conjunction with the FSSA would be affiliated to CBS.  Membership of CBS would automatically entitle members to the benefits of Medix which provides competitive insurance for house, property and possessions with certain unique surgical policies such as hand insurance.
  2. Surgical Expert: is another recently created company designed to provide expert witness comment for surgeons in dispute with their Trust (employer) or the GMC (the regulator). Recent evidence demonstrates that up to 20% of all surgeons are under investigation at any one time.  The stress and uncertainty associated with these investigations has enormous effects on the welfare and wellbeing of surgeons.  Any initiative that might help resolve these issues expeditiously will be welcomed by the profession. Membership of CBS would automatically entitle members to the benefits of Surgical Expert Ltd.

The CBS intends to continue to work closely with the Federation of Surgical Speciality Associations (FSSA) which has been instrumental in achieving this 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).  The CBS, if recognized, would continue to work closely with the FSSA.  In many respects the activities of the FSSA in recent years represent the aspirations of the CBS.  

Examples include:

  1. Dealing with surgeons in difficulty
  2. The future of the district general hospital
  3. Training surgeons of the future
  4. Choosing wisely: cost effective 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 would co-opt 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. 
  4. There are inconsistencies in the means by which discretionary points are awarded.  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 would neither be feasible nor sensible for the CBS to attempt to embark simultaneously on all of these issues. An early intention of the CBS would be to conduct extensive research amongst surgeons to determine a consensus on which issues are most important.  Having done this CBS would research that particular issue and lobby on behalf of surgeon members.  Such lobbying would include not only parliament but also existing trade unions such as the BMA and the HCSA.

Once up and running the CBS would have 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 quickly will involve the following:

    a. 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.  It is our intention to create twitter feeds, WhatsApp facility and Facebook on a regular day to day basis to facilitate the determination of those employment issues that cause most concern.  Use of social media will allow large numbers of surgeons to express opinions in short periods of time.  Whilst CBS does not at present have formal negotiating rights with employers it is hoped that by harnessing the opinions of large numbers of surgeons that these views will be difficult to ignore.

    b. Many surgeons are familiar with dealing with the media.  CBS would use current contacts to facilitate dissemination of information and by so doing increase 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).

    c. The FSSA, with which CBS will maintain a close working association, 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 would use “survey monkey” to assess the depth of feeling on a wide range of employment issues.  When a dominant theme emerges CBS would seek to establish policy on behalf of surgeon members and then lobby on their behalf.

    d. One of CBS’ first actions will be to write to all Trusts and other NHS employers in the devolved nations. CBS can access names of all CEOs and Medical Directors from Trust web sites thereby rapidly establishing databases of senior NHS staff.  Similarly, access to FSSA mailing lists as well as review of Trust web sites will permit rapid accumulation of databases which will include the names and details of all practicing surgeons in the UK. 
  4.  Negotiation on behalf of surgeon members is unlikely to be effective until such time as CBS is seen to represent the views of the surgical community. At this stage we would seek meetings with:

    a.Parliamentarians (as discussed above)
    b.Chief medical officer
    c.NHS medical director (currently a surgeon)
    d.Local MPs (as local hospital issues relating to the provision of surgical services are often very contentious)
    e.Patient liaison groups: as a group we have contact details of patient liaison groups across the speciality spectrum. Having the support of patients is likely to prove important in negotiation of terms that enhance the provision of surgical services

The plan over the coming weeks is to:

  • establish an administrative office
  • establish an executive and appoint officers
  • seek to inform all surgeons
  •  inform parliamentarians
  • inform all hospitals where surgical procedures are undertaken
  • inform all Colleges and Specialty Associations.
  • Finance

An initial annual membership fee of £100 is being proposed.  As such, even a modest membership of 500 surgeons in the first year would permit appointment of administrative staff which would lead to additional recruitment and extension of member benefits.  If the CBS is to be successful it needs the support of surgeons from all specialities. Your interest can be registered at Membership forms will be produced in the early part of 2018. Your views on the creation and development of CBS would be welcomed.



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

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