The acrimonious dispute between the British government and its junior doctors has entered uncharted territory, as junior doctors prepare for a series of five-day walkouts unprecedented in the history of the National Health Service (NHS).
The first strike, announced Aug. 31 and set for Sept. 12–16, was called off on Sept. 5 after NHS leaders, senior doctors and many individual juniors expressed concern that the short notice threatened patient safety.
But three further five-day strikes are still planned for October, November and December.
The contract impasse began late in 2015. After two years of fruitless negotiations the government sought to enact its election promise of a “Seven-day NHS” by unilaterally drawing up a contract with lower weekend pay rates for England’s roughly 55 000 junior doctors — one-third of the country’s physicians.
The junior doctors voted 98% in favour of rejecting that contract and this spring launched a series of two-day strikes to press their case. The government made changes and offered a new contract in May, which included, among many provisions, an annual bonus for weekends worked as well as setting maximum hours per week to safeguard safety. The British Medical Association (BMA) junior doctors’ leaders recommended their members accept the contract.
But in an early July vote, 58% of members voted against it, prompting the resignation of their union leadership and the installation of a new junior doctors’ leader. After long internal debate, the juniors announced the current series of strikes.
Consultants had supported the spring walkouts, promising to fill the gaps and ensure patient safety, but the Association of Royal Medical Colleges called the new strikes “disproportionate.”
Other former supporters also began to wobble. The association representing NHS chief executives said the September strike gave insufficient notice and would endanger patients. A YouGov poll for The Times found that public support for the five-day strikes was 34%, with 48% opposed.
The General Medical Council, responsible for physician regulation, wrote a new guidance warning that doctors’ duty to their patients trumps the right to strike, and any doctor who refused to work after their NHS employer declared their services were needed to ensure patient safety risked disciplinary action. This is a far harder line than the council had taken earlier this year.
Cracks appeared within the BMA itself. BMA Chairman Mark Porter, making the rounds of the television news programs to justify the five-day strikes, said the BMA Council was firmly behind them but did not dispute widespread reports that the vote in favour had been a narrow 16-14 margin.
“For weeks we heard nothing,” then the strike announcement came “out of the blue,” junior doctor Francesca Silman told CMAJ. “You can’t do that. We need to prepare, and know what we’re actually doing it for. There has been very poor communication from the union. They need a clear strategy to bring members on board.”
The junior doctors have no alternative contract of their own on the table, and it is by no means clear that all of them want the same things. Health Secretary Jeremy Hunt has stressed that while pay might be shifted from weekdays to weekends or vice versa, the total amount on offer is set in stone. That position has only hardened since Brexit further limited the government’s budgetary options.
Silman is one of five activist junior doctors whose crowdfunded lawsuit will challenge Hunt’s right to impose the contract in a High Court judicial review, slated to begin this week. Yet even Silman is circumspect about the coming strike action.
“I worry that we’ve backed the government into a corner, that they’re afraid of demands from other public unions if they accede to ours. That it has become a bigger issue for them.”