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NHS faces more disruption as junior doctors reject new contract

5 July 2016

The NHS is facing fresh disruption after junior doctors and medical students across England voted to reject a proposed new contract.

On a turnout of 68 per cent – around 37,000 junior doctors and medical students – 42 per cent voted in favour of the contract, while 58 per cent voted against it, the British Medical Association said.

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Johann Malawana, who led the BMA’s junior doctors’ committee and had recommended that his members accept the new deal, is to stand down to allow a new leader to take negotiations with the government forward.

Malawana said that, having spoken to many medics across the country, it had become clear that some had "reservations about what it would mean for their working lives, their patients and the future delivery of care in the NHS".

There was "considerable anger and mistrust towards the government’s handling of this dispute", he added.

Health Secretary Jeremy Hunt said the outcome was "extremely disappointing" given that the contract "was agreed with and endorsed by the leader of the BMA junior doctors’ committee".

It is unclear what will happen next, says The Guardian, but there is the possibility of further industrial action as the Hunt had warned previously he would impose the contract from October if it were rejected.

In a statement today, the Health Secretary highlighted the turnout, saying it meant only 40 per cent of those eligible had actually voted against the deal. "We will now consider the outcome," he said.

In an article for The Independent, entitled: "Why my fellow junior doctors have rejected Jeremy Hunt's contract, despite the BMA's endorsement", junior doctor Rachel Clarke lamented Hunt's "year of slandering, smearing and undermining" junior doctors.

"Gaps in our rotas are rife as missing doctors have quit the profession in despair. Every one of these gaps puts patients at risk," she writes.

Junior doctors: Hunt accused of 'computer says no' attitude

19 May

Health Secretary Jeremy Hunt has been criticised for having a "computer says no" outlook in the long battle over the new junior doctors' contract.

A deal has finally been struck between government negotiators and the British Medical Association (BMA) after drawn-out talks and several strikes, but Labour says the pact could have been made months ago.

In a House of Commons debate today, Heidi Alexander, the shadow health secretary, said: "What is now clear, if it wasn't already, is that a negotiated agreement was possible all along. So I have to ask you, why couldn't this deal have been struck in February? Why did you allow your pride back then to come before sensible compromise and constructive talks?

"When you stand up you might try to blame the BMA for the negotiations breaking down, but you failed to say what options you were prepared to consider in order to ensure that the junior doctors who work the most unsociable hours are fairly rewarded. It was a 'computer says no' attitude and that's no way to run the NHS."

Hunt rejected her claims, although he admitted on BBC Radio 4 earlier in the day that he had "lessons to learn" from the protracted dispute.

"I don't say I was responsible for the industrial action because I think that was a decision taken by the BMA and initially caused by the fact that at the time there was not willingness to engage with the big issues that we needed to resolve to deliver a seven-day NHS," he said.

Dr Johann Malawana, the BMA's junior doctors' leader, said "intense but constructive talks" had led to a deal that offered the "best and final way" of resolving the dispute.

The key points of the deal include:

  • Premium pay for Saturdays and Sundays if doctors work seven or more weekends in a year, ranging from three per cent for working one weekend in seven to up to ten per cent if they work one weekend in two.
  • A premium of 37 per cent for any night shift from 8pm onwards that lasts more than eight hours.
  • A basic pay increase of 10 to 11 per cent, down from the 13 per cent originally offered.

However, The Guardian points out that the BMA still needs to put the deal to its 45,000 members for ratification and is "facing a growing backlash from junior doctors furious at what some called 'a sellout' and 'a joke'."

Junior doctors: Hunt willing to pause introduction of contract

05 May

The government has said it is willing to pause the introduction of the new junior doctors' contract for five days from Monday.

The move comes after the Academy of Medical Royal Colleges issued a plea to both Health Secretary Jeremy Hunt and the British Medical Association to commit to a "serious attempt to reach a resolution through genuine dialogue".

In a letter to the academy, Hunt said the government remains committed to introducing the new contract in August, but is willing to agree to a temporary suspension "to play our part" in attempting to reach an agreement.

"This is a significant show of good faith by the government to break the deadlock," he said. "We now need the BMA to agree to negotiate on Saturday pay, the biggest single area of difference, in order for the talks to proceed."

In return, the BMA said it was prepared to suspend any new threats of strikes for five days, but warned Saturday pay was not the only sticking point.

"As suggested by the academy, we are keen to restart talks with an open mind. It is critical to find a way forward on all the outstanding issues – which are more than just pay – and hope that a new offer is made that can break the impasse," said Dr Johann Malawana, the chairman of the BMA junior doctor committee.

Shadow health secretary Heidi Alexander welcomed the pause offer and urged her Tory counterpart to "put his pride to one side" and resume negotiations.

The pause "raises the prospect of fresh talks being held at the start of next week", says The Guardian.

But the new development does not guarantee new discussions will take place, says the Health Service Journal's Shaun Lintern.

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Junior doctors' strike 'would be settled with Brexit'

26 April

Junior doctors taking part in an all-out strike today would be given pay rises if the UK voted to leave the European Union in June, Vote Leave has suggested.

Thousands of junior doctors walked out at 8am this morning to protest a new contract due to be imposed upon them by the government this summer.

It is the first time in NHS history that services such as A&E, maternity and intensive care have been hit by strike action.

In a statement, Vote Leave declared the pay dispute "could be settled with just over two weeks of our EU contributions".

Promoting a new campaign video on its website, it said: "We send £350m to the EU every week, money which would be much better spent on our priorities like the NHS.

"Our public services are already under huge pressure from uncontrolled migration.

"The only way to take back control of our borders and ease the pressure on our NHS and public services is to Vote Leave on 23 June."

The move was greeted with "dismay and anger" in Whitehall, where a source dismissed the claim as "bonkers", says The Times.

Downing Street insists the dispute is "not about how we save money but how we put the NHS on a stronger footing to deliver better patient care", while Health Secretary Jeremy Hunt has said that "no trade union has a right to veto a manifesto promise voted for by the British people".

Today's strike is due to end at 5pm, but another will take place during the same hours tomorrow.

"Hospitals can request that junior doctors return to work if needed, but as yet no NHS trust has raised the alarm," says the BBC.

An Ipsos Mori poll for the broadcaster found that 57 per cent of voters supported the strike and 26 per cent were opposed.

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Jeremy Hunt turns down chance to stop junior doctors' strike

25 April

Junior doctors providing emergency care are to go on strike for the first time tomorrow after Health Secretary Jeremy Hunt rejected a cross-party plan for a new work contract to be piloted before a national roll-out.

MPs had called for the contract to be "independently evaluated in operation and a study made of its impact on mortality rates at weekends", reports the BBC.

However, Hunt dismissed the Labour-brokered proposal as "opportunism".

The Health Secretary said that only 11 per cent of junior doctors will start new contracts in August, meaning they are already being brought in gradually.

"We're staging implementation to ensure it works as intended. Any further delay just means we will take longer to eliminate weekend effect," he said.

Doctors union the British Medical Association had said its representatives "would discuss the possibility of calling off the strikes if the government agreed to limited trials of the contract", but speaking on the BBC's Andrew Marr Show yesterday, Home Secretary Theresa May said the decision to impose contracts unilaterally would stand.

Lose-lose situation

Clare Marx, the president of the Royal College of Surgeons, said the dispute was a "lose-lose situation" for all parties and that the college strongly backed Labour's proposal as a way out of the current impasse.

With the mass walkout due to begin tomorrow morning and expected to affect accident and emergency, maternity and intensive care units, as well as general services, hospitals have been making "desperate efforts" to prepare, reports the Daily Telegraph.

It adds that heavily pregnant women and cancer sufferers are among more than 125,000 NHS patients whose treatments have been postponed.

Almost 13,000 operations have been delayed and 113,000 appointments cancelled in an attempt to ensure essential services can still be run.

Lindsay Hoyle, the deputy speaker of the House of Commons, said he had requested the help of the Army to support a "chronically understaffed" A&E department in Lancashire.

Junior doctors begin fourth 48-hour strike

06 April

Junior doctors in England went on strike this morning at 8am, their fourth 48-hour stoppage this year. More than 5,000 non-urgent operations have been cancelled, NHS managers say.

The BBC says un-named sources believe there is "now little dialogue between ministers and the union" after the government said it would impose new contracts this summer.

Doctors' groups warn the revised conditions are unfair and will lead to them working longer hours, which they say will be unsafe for patients.

The NHS has produced advice for patients during the strike, most of which is "common sense", according to The Guardian. The service's Twitter account said hospitals would get in touch if they needed to rearrange operations.

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Support for the doctors remains strong. Actor Stephen Mangan tweeted that he and four of his co-stars from the medical TV comedy, Green Wing, will today visit Northwick Park Hospital, where the series was filmed.

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Meanwhile, actress Vanessa Redgrave was due to join a rally in central London this morning, along with junior doctors, nurses, teachers and members of the fire service union before a petition of 120,000 signatures opposing the new contracts is presented to the Department of Health.

In addition to the current series of walkouts, emergency care staff are expected to go on strike for the first time in the NHS's 68-year history at the end of this month.

Junior doctors launch three strikes and a legal challenge

24 February

The bitter conflict between the British Medical Association and the government has entered a new phase, with the union launching a legal challenge against Health Secretary Jeremy Hunt's plan to impose new contracts on junior doctors.

Three more 48-hour strikes have also been announced to take place over the next two months. The stoppages will be held on Wednesday 9 March, Wednesday 6 April and Tuesday 26 April, beginning at 8am.

Dr Johann Malawana, the BMA's junior doctor leader, said he has spent the past two weeks consulting with members who "cannot and will not accept" the imposition of the new contracts, which include paying doctors less to work on Saturdays.

"The government must put patients before politics, get back around the table and find a negotiated solution to this dispute," he said.

The union claims ministers have "failed to assess whether the contract might discriminate against particular groups of junior doctors", says The Independent.

Politicians have imposed the contract on junior doctors "knowing there is a potential for further industrial action", says The Guardian. "But they are also convinced that the opposition will start to ebb away once the contract comes into force, arguing that most will see a small rise in pay and an improvement in their working hours."

David Cameron's official spokeswoman said: "It's regrettable if they are going to strike again. I'm sure discussions will continue."

Junior doctors to 'speak with their feet' over enforced contracts

12 February

The government's decision to impose changes to junior doctors' working hours and contracts in England could prompt a mass exodus of medics that would seriously harm the NHS, unions say.

Thousands of junior doctors returned to work yesterday, after a second 24-hour strike over plans for a seven-day health service.

After its final offer was rejected, the government said it will impose the new contracts, "setting the scene for renewed confrontation and the possibility of further strikes", says The Guardian.

Junior doctors reiterated that imposing contracts was a "huge gamble" because it would lead to dangerous working practices that would put patients at risk.

But while the BMA leadership is "considering all options", it fears more strikes would damage the public support junior doctors have so far enjoyed, says The Independent. A YouGov poll said 49 per cent of people support the strike action.

Union leaders say some doctors could chose to "speak with their feet" and leave the NHS altogether.

While the NHS is effectively a monopoly employer, it would be a risk to assume that means there will be "no impact on the numbers staying in the health service", says the BBC's Nick Triggle. "Imposition may solve a short-term problem, but the long-term effect is unknown," he adds.

Already, half of doctors who finish their training step off the career ladder by not specialising. Some go abroad while others are drawn to opportunities in alternative sectors, including the pharmaceutical industry.

"To lose a large swath of doctors in the early stages of their careers would be a disaster for the NHS," says Kitty Mohan, the co-chairman of the BMA's junior doctors committee.

The Welsh government has already extended a "very warm welcome" to English doctors seeking to escape new contracts, says The Independent. Wales and Scotland have previously said they will maintain the existing contractual arrangements, prompting some junior doctors to plan an "escape" to Scotland, according to BuzzFeed News.

Junior doctors reject Hunt's 'final' pay offer

11 February

The dispute between junior doctors and the government has intensified, with reports suggesting the medics have rejected a final "take-it-or-leave-it" pay offer.

The package included a concession on Saturday pay but the British Medical Association said it was not enough. The rejection "is expected to lead ministers to announce that they are going to impose a contract on doctors", says the BBC.

According to the Daily Telegraph, Health Secretary Jeremy Hunt could act within days to force through a new deal.

"We do need to have resolution on this," Hunt has said.

A second strike by junior doctors yesterday showed "signs of dwindling support", the newspaper says. Including those on emergency duties, 43 per cent of doctors turned up to work, compared with 39 per cent in January.

The dispute stems from changes to payments for unsocial hours as part of the government's plan to introduce seven-day services within the NHS.

The government has made several offers to the doctors, including one in November that promised an 11 per cent rise in the basic levels of pay. However, that offer would have treated Saturday as a normal working day, with no anti-social working-hours bonus.

The BMA proposed instead that basic pay should rise "by about half the 11 per cent offered by ministers in return for Saturday not to be treated as a normal working day", the Telegraph says.

The two sides failed to reach agreement before a deadline set by Hunt elapsed last night.

Junior doctors' strike: second 24-hour walkout begins

10 February

Junior doctors are holding their second 24-hour strike this year, in response to the continued deadlock over changes to their contracts.

From 8am Wednesday to 8am Thursday, the majority of the medics will be providing emergency cover only. Almost 3,000 scheduled non-urgent operations have been cancelled.

Tensions have been high between the British Medical Association (BMA) and the government since the new contract was unveiled as part of Health Secretary Jeremy Hunt's "seven-day NHS" plan to lower weekend mortality rates. Around 38,000 doctors – around two-thirds of the workforce - took part in last month's walkout in protest at the changes.

Currently, junior doctors receive higher pay for night-time and weekend shifts. The government wants to include Saturday as a normal working day and reduce the hours eligible for higher pay during the evenings. The BMA says this could represent a pay cut of between 15 and 30 per cent.

There are also concerns the new contract could force the medics to work longer shifts, with a potential impact on patient safety as well as doctors' wellbeing.

The Health Secretary has suggested a "nuclear option" could be used if no agreement is reached, using the government's power to forcibly impose the terms of the new contract without further negotiation.

However, a new survey seen by The Independent says 90 per cent of junior doctors would consider quitting the NHS if the new agreement was imposed in its current form.

BMA chief Dr Mark Porter told the newspaper that committed young doctors had been driven to the drastic step of industrial action by the government's insistence on "putting politics before common sense".

Meanwhile, polls from both Ipsos Mori and YouGov show the strike action has the public's backing, with 45 per cent of YouGov's respondents blaming the government for the deadlock compared to 12 per cent who blamed the BMA.

Junior doctors' stirke back on after talks flounder

05 January

A series of strikes by junior doctors in England, called off at the end of last year, is back on after talks with the government broke down.

A 24-hour strike next Tuesday will be followed by a 48-hour walkout starting on 26 January and another one-day strike on 10 February, the British Medical Association (BMA) has announced.

The dispute between junior doctors and the government was prompted by the introduction of a new contract.

A last-ditch offer made before last night's midnight deadline is believed to have included a larger increase in basic pay. But the talks broke down because the increase was offset by curbs to other parts of the pay package, including unsociable hours payments.

The government has said the changes are needed to create more seven-day services, but the BMA has warned it could lead to doctors being over-worked because safeguards designed to prevent excessive hours are being weakened.

The Health Secretary Jeremy Hunt told BBC Radio 4's Today programme that the talks "lasted less than an hour" and that he had thought they were "making very good progress".

"We've offered protection for 99 per cent of doctors, so 99 per cent will either see their pay protected or go up," he said.

In response, the BMA's chairman Dr Mark Porter described the 99 per cent figure as "Government propaganda".

He told the Today programme: "The Government is, understandably, putting round the fact that agreement is almost there.

"It's almost there in their mind but not in the minds of junior doctors."

He added: "An 11% pay increase doesn't compensate when you take away a 31% average payment for working the unsocial hours. Anybody can do the maths on that."

All three of the strikes will start at 8am. During the first two stoppages, junior doctors will provide only emergency care, the BMA says, while the final strike will involve a full withdrawal of labour.

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