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Gold, incentives and meh

Junior doctors to withdraw emergency care in escalation of action

Junior doctors will fully withdraw their labour, including emergency care, in an escalation of their industrial action, the BMA has announced – the first instance of this ever happening in the NHS.

A statement from the BMA said that the 48-hour industrial action planned for 26 April will now change to full withdrawal of labour between 8am and 5pm on 26 and 27 April.

This will follow earlier action – a 48-hour walkout on 6 April – which will continue as planned.

The chair of the BMA’s junior doctor committee Dr Johann Malawana said the Government had left them with ‘no choice’.

The committee had planned earlier this year to withdraw all emergency cover, but did not go through with the action as talks with the Government were progressing.

Junior doctors have already held a 48-hour strike since the imposition of the junior doctor contract, with two more planned for early and late April.

The BMA is also taking the Government to judicial review over the ‘embarrassing’ revelation that the Government failed to carry out an equality impact assessment before imposing a new contract on junior doctors in England.

Dr Malawana said today: ’No junior doctor wants to take this action but the Government has left us with no choice. In refusing to lift imposition and listen to junior doctors’ outstanding concerns, the Government will bear direct responsibility for the first full walkout of doctors in this country.

’The Government is refusing to get back around the table and is ploughing ahead with plans to impose a contract junior doctors have no confidence in and have roundly rejected.

’We want to end this dispute through talks but the Government is making this impossible, it is flatly refusing to engage with junior doctors, has done nothing to halt industrial action and is wilfully ignoring the mounting chorus of concerns over its plans to impose coming from doctors, patients and senior NHS managers. Faced with this reality what else can junior doctors do?’

Health secretary Jeremy Hunt last month announced that he was imposing a contract on junior doctors after talks broke down over the issue of evening and weekend pay, with the Government refusing to step back from its decision to remove ‘unsociable hours’ pay premiums from Saturdays and weekday evenings.

A Department of Health spokesperson said: ’This escalation of industrial action by the BMA is both desperate and irresponsible – and will inevitably put patients in harm’s way.

’If the BMA had agreed to negotiate on Saturday pay, as they promised to do through ACAS in November, we’d have a negotiated agreement by now – instead, we had no choice but to proceed with proposals recommended and supported by NHS leaders.’

What the imposed contract includes

The junior doctor contract imposed by health secretary Jeremy Hunt includes:

  • An increase in basic pay of 13.5%;
  • Redefining the definition of ‘plain time’ to include Saturday from 7am to 5pm;
  • Paying a premium of 30% for Saturday ‘plain time’ working, if the doctor works one in four weekends;
  • Reduce the definition of ‘safe hours’ from 91 to 72 hours a week;
  • Doctors will not work more than four consecutive nights – down from seven currently;
  • The maximum number of consecutive ‘long days’ will be reduced from seven to five;
  • A new ‘Guardian’ role will be introduced, with the authority to impose fines for breaches to agreed working hours, which will be invested in educational resources and facilities for trainees.

Read more here

Readers' comments (75)

  • Vinci Ho

    Johann
    Freedom from fear
    Freedom from regret....

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  • This is wrong. Nothing justifies this. Brings the whole profession into disrepute and terminally breaks bond with the public. This is so wrong.

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  • Good.This is the only thing that will make this government listen. I hope they extend it to a further 48 hour complete walk out with no emergency cover. If the junior doctors lose public support then so what?

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  • 02:47 pm- If nothing justifies this, then how do you justify what the Government and Hunt is doing with the Junior doctors, the consultants and Gps. How do you justify the long term suffering of not only doctors, but patients and NHS as well due to the imposition of contracts.
    Think about it- Hunt tried to target the supposedly weakest link in the NHS- with Consultants/ GPs/ Nurses to follow suit.
    Its because of GPs like yourself, the government gets away with any and everything.
    I salute the junior docs to have a pair, about time the rest of us follow suit and some out there, grow a pair.

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  • I fully support the junior doctors but there must be another way. If anyone dies as a result of their withdrawal from emergency care they will soon lose public support.

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  • 252 This is not a battle The BMA have backed into a corner by being belligerent and now are ruining the professions reputation with the public. This will all end in tears and it could have been so different - witness the 2016/7 GP settlement which was achieved by negotiation

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  • 02:47pm - there is no bond with the public for GPs and junior doctors any more. They elected this government. This government is running an unsustainable and workforce destroying system. The juniors have nowhere else to go - you could argue that even this is too timid. Perheps even a longer but harsher withdrawal would bring the government to some realism in a shorter period of time, saving patients and doctors in the medium term.

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  • Time to stop fretting about public support.

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  • Its about time this happened. For all those people that think doctors should not strike should go into work!

    I can not see how the government is willing to pay for bail outs of banks and willing to keep the banking industry in the UK (which is good for the economy) but will not invest in the future of health care!

    The DDRB has suggest pay rise for the medical profession of years but the government has rejected them. Their own parliamentary pay review board has suggested a pay increase for themselves and they have accepted that as "it is an independent body" isn't the DDRB?

    Doctors should not have to work longer hours for less pay with their profession being put through the mud by other doctors and the media!
    The NHS was set up for a 7 day emergency service. We have that. We do not have a 7 day routine health care. No country does. It is unsafe and not good for patient care to work shift patterns that will be expected of doctors with the new contract.

    We should stand shoulder to shoulder with everyone that helps run the NHS! From nurses to porters. As well as the teachers and firemen and other public bodies who are being drowned of resources and working harder and harder.

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  • Supported. Self respect, dignity and pride in the work clinicians do and the years of sacrifice for an unvomparable cause. The real public will support the only lasting clean profession out there. The rest will appreciate you one day.

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  • To GP who are worried about loosing public support.
    Stop worrying about public support. Public is not worried about your loss of income. They don't care whether you have worked 12/14/16 hrs. All they care about is free health care and don't want to contribute to it. Our job is to see that they get safe/ good health care and we should get appropriately paid for doing that job. How funding is arranged is government's problem not ours. If they can't fund it properly then be ready to compromise.
    Lets fully support our Junior doctors. I hope all GP call in sick one day to show our support to JD , lets see what the ---- NHSE does.

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  • I would stop fretting about losing public support - be really honest - how many patients really, really care....and how fickle they are and how short their memories anyway.
    Let's not kid anyone - patients are only happy when they get what they want - I recall complaint after complaint after complaint because Dr wouldn't give antibiotics / Dr wouldn't refer for ??? / Dr didn't do this or that or the other - 99.99% of which our complaints review shows were not clinically indicated - and the other minority is one opinion versus another and far from clear cut.
    This is the only game in town and the stakes are high - the NHS as we know it is very broken after career politician after career politician pushing through idealogical policies that are not working.
    If one branch of medicine (in this primary care) in all its form does not support another (2nd care JDs) then there is no voice of the NHS - only factions. Please don't let Hunt see cracks in the professional support the JDs have.

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  • Hopefully the threat of withdrawing emergency care will be enough to force the Government to be fair to doctors and they won't have to actually do it.
    In fact, long term ,many more lives will be lost by losing the workforce than a 48 hour strike, so overall it may still be in the patients interests for doctors to strike. When you are very ill and waiting to be seen, with reduced numbers of doctors your likelihood of dying increases, obviously.
    As the poor conditions in the NHS become more obvious, the intelligent children will no longer want to do medicine .This will mean the doctors of the future may not be as bright, and this will also affect the death rate . It is not so black and white.

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  • good

    the NHS is everyone's

    the consumer / public / taxpayer has to decide if they want the service they say they want then they have to pay for it.

    staff have already taken yearly pay cuts and absorbed increased expenses to prop the system up. the suggested contract is bad news for doctors and will lead to such a demoralized work force that the quality of care will plummet.

    it is common sense that if you are not increasing the work force numbers and want to increase availability of services - the same staff are going to have to work longer hours. The CQC is a puppet and will pay lip service to breaches in hours. We have all been there with 100 hour weeks. In our time if something happened it would raise an eyebrow and then we'd move on. Now if something happens it will end a juniors career. It is not fair on them.

    the BMA are doing this to bang the drum to make sure the public heeds their warnings.

    sadly the public don't care enough and feel this is a drs vs state argument. it is not - the NHS is the public and if they don't fight for it - come August it will be gone as juniors will walk. those talking about don't do this and stick it out are deluded - think about it - this is the most extreme strike action ever. Juniors are not mildly upset they are fuming and come August I can see a lot leaving. You may choke on your cornflakes on the thought of strikes but how about having no doctors after August or no hospitals.

    If the public abandon juniors then doctors can feel they did their best to warn the public and can leave knowing they did the right thing.

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  • All health staff, nurses and doctors should give three months notice of a complete walk out.

    Desperate times, desperate measures.

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  • Malawana has what Nagpaul hasn't

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  • Public opinion may not bother some of you, but it does bother the government very much. We'll see, but I suspect the government will hold their line and allow the junior docs to be the first ever to behave so unprofessionally as to completely abandon their posts and their bond of trust with their patients. That's how it will be presented.

    So now, it is not only the relatively few who will suffer longer waits for routine care but, potentially, everyone in the country will personally feel at risk when emergency care is compromised. They will not blame the government, but those idly standing around on the picket line, as they now see it, just wanting a bigger salary.

    I personally think this escalation is wrong and is very likely to completely backfire. Just because the government has badly mishandled the affair, it does not give license to the profession to stoop even lower. The battle is lost.

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  • Enough is enough. We should all walk out.

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  • We can only fight to the same rules that this health secretary employs. I wholly support this escalation in industrial action. I fear this government more than I fear the actions of our young doctors. Heads up ladies & gentleman & apply pressure the likes of which this government will understand.

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  • Fight the power!

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  • The JDs have to win. If not we will all (doctors, nurses, PAMs, porters, ambulance staff..) have a 30% drop in income and working 7/7. Support the JDs

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  • Don't worry about losing public support.

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  • 4:07pm This imposed junior doctor contract and the decade of abuse of GPs cannot continue. Both will cause the unsustainable loss of doctors in total through early retirement, career change, emigration and burnout. Many medical students are now qualifying and immediately choosing other careers. Hardly anyone is choosing GP and if they do, it is part-time (full time). The awful truth is that the public will sleep walk into a collapsing service, that from a GP perspective, is in its terminal death throws. Worrying about their support and opinions is irrelevant. You can't use a contract as a tool if you haven't got a workforce. This government is destroying the doctor workforce. Turning this around will require drastic measures and this will only be the start.

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  • This is the right thing to do OUR juniors have no choice we should back them.Look at the crap deal the GPC have got for us and try to sell it as a victory.If only the GPC had the fight and gumption of OUR juniors.The BMA old guard needs a good clear out we need young blood with the will to fight for us and our patients not just to roll over and let the tickle our belly with and OBE etc to be placid. Malawana needs to be promoted the old guard should be ashamed.

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  • I'm a GP, and fully support the junior doctors in their fight: but this is a mistake. As soon as the Daily Mail get so much as a whiff of the first child to die because of a lack of emergency cover, watch the public support melt away faster than a snowflake in hell. There are other possibilities, and frankly making the strike emergency cover only over an indefinate period would have been a much more sensible option.

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  • Never in history as there been such underfunding of the NHS.

    They came for social services.
    Then they came for junior doctors.
    Then they will come for nurses.
    Then they will come for GPs.
    Then they will come for consultants.

    Then the NHS will be completely privatised with all of us regarded as simple 'workers' with terrible terms and conditions. We will not even have any control over the management of clinical conditions. This will all be done through protocols with big pharma making loads. Many of the jobs done by doctors will be given to poorly trained staff

    We must support the JDs

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  • Withdrawing emergency cover is extremely risky and unnecessary. In 1975 the juniors didn't withdraw emergency cover but still won because of increasing waiting lists which are very bad news for the government. Stick to plan A. Alienating the public and juniors losing their support is Hunt's strategy

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  • will consultants cover? will that not be safer? less tired staff?

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  • The Junior doctor's are showing the cardigan GP'S the way forward. Junior doctors will not accept unfair imposition of the contract. The cardigan GP'S have to wake up and smell the coffee!!

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  • Consultants will be there to ensure safety during these strikes so stop saying it will be unsafe. Elective work will be cancelled. It will not be unsafe for patient's being seen by Consultants!!

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  • Take of your cardigan's and stand with the BMA on this!

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  • 6.05 thank for stating what many of us have saying all the time. Now get patients to watch the amazing Philippa Whitford explain all in terms easy enough for the govt even to understand http://parliamentlive.tv/event/index/641c6fb7-a2a0-47e0-8b10-e3c99e765c2b?in=17%3A38%3A28&out=17%3A48%3A40

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  • @|Anonymous | GP Partner|23 Mar 2016 3:56pm

    'Malawana has what Nagpaul hasn't'

    GOLDEN BALLS

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  • The vast majority of GP's/Consultants support our junior doctors. Its a very difficult decision that will be hard for many but it is vital to ensure that the profession is not walked all over. As a GP partner I am ready to resign as the NHS is falling apart.

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  • medicine tastes awful

    This is only stage 2; I assume stage 3 is mass resignations.

    To Mr Hunt’s GP – could you please given your patient an indefinite not fit to work certificate (Med 3), he clearly is not fit to work or hold office. Also please refer him for a hearing test and a hearing aid and he just does not listen.

    A tyrant who has no appreciation what these junior doctors have to put up with. Thanks to him NHS – a health service is in terminal stage. RIP.

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  • If people want emergency care they will have to get used to paying for it. They could go private during the strike and this option should be publicised.
    In other countries this is the norm. It will certainly be the norm in this country if the NHS collapses.
    It should be treated as a wake up call for the public.
    As there is an option this needs to be put out there.

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  • "My child died because the BMA fell out over an Equality Impact Assessment"....discuss (with a bereaved parent).
    Yes,the NHS is in terminal decline(despite being better funded than at any time in its history).Failure of the concept does not justify killing patients.

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  • I support, there is no other way unfortunately

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  • The NHS under Mr Hunt's watch is failing seriously.

    I see the key staff - the Juniors just starting out in their career jumping ship. This now is a seriously matter for the future of the NHS.
    Whatever strike,emigrate,change career, resign, do whatever needs doing- WE ARE BEHIND U.

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  • What do you do with a Govt that imposes unsafe and unfair Contracts? striking is not going to be good.
    Mass resignation is the only answer.
    The BMA can set up chambers and sell services from a central base.
    Striking = for how long, how many days, weeks, months?
    Resign. GPs could sort this whole thing tomorrow.
    Resign from 1/4/17. Set up chambers, Federations, whatever is needed to provide the healthcare the nation needs.
    Payment maybe like legal aid.
    I see there was a legal aid bill for 400000 pounds for one defence who got jailed anyway. A solicitor charged 140000 pounds for this ONE case.
    Ask the solicitors. They know how to do it.
    Almost 2 years of my work for ONE case.

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  • I think withdrawing emergency care is wrong personally. There could be many people dying as a result of this...

    I understand that hunt negotiating with hunt is never going to achieve anything but prior to this JDs had a measure of sympathy from the public....... be warned that the media will have a field day if deaths result from this

    Hopefully in this game of chicken the government will blink first

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  • I would have suggested longer (indefinite?) emergency-only strike, rather then this, very risky.

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  • Junior doctors are doing the right thing and as a GP - I fully support our juniors.

    They have to do this. Why? when the NHS collapses after they leave - no one can say they didn't do their best to warn everyone. So rather than trying to leverage emotional blackmail and bully the juniors listen to what they are saying and lean on your local politician to support them. Juniors have a choice - come August they can locum, emigrate, change career, study etc. But once the NHS is gone - it's gone. There are only 4 months to save the NHS.

    Many assume come August it will be business as usual - I don't think so. How many need to leave to cause a collapse ?5% ?10%.

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  • Other healthcare professional23 Mar 2016 8:55pm
    What evidence do you have to base your remarks on?

    The strike will be a consultant led emergency strike. Who would you rather see as a patient a Consultant or a junior doctor? It is completely baseless to say it will be unsafe for patients. The emergency units, and wards will be staffed by senior consultants with many years of experience.

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  • Sessional/Locum GP23 Mar 2016 9:32pm

    Many thanks for your support and comments. It is also time for the GP'S and Consultants to stick up for the NHS and negotiate a better deal with their own contracts.

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  • You all need to listen to Dr Hamed Khan a GP who is standing up for junior doctor's and the NHS:

    http://www.lbc.co.uk/watch-passionate-iain-takes-on-doctor-over-strike-127431

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  • I had another hell-ish day at work. We have no choice to do this. Our current situation is unsustainable and unsafe. We have to use force, if we give-in, expect things to get worse and patients suffer as a result. I fully support the juniors.

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  • I think the public will support the junior doctors. I worked in NZ in the 1990s and there were 3 strikes over a few weeks when I was there. No emergency cover was provided. The nz govt was trying to bring in UMT style payments like the uk to replace the treble time payments nz doctors got after midnight. The govt capitulated with each strike being called off after an hour or so. It was weird watching ambulances arrive at a and e with one consultant running around trying to cope whilst the juniors watched from the picket line. The press at all times supported the doctors....

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  • @0.41 today

    The problem is that the world is now a different place. We have a very determined Govt that has support from right wing media that will not support JDs. Joe Public is fickle. They have been very supportive of JDs so far, but judging by the comments in the DM today, they have switched allegiance. The question is does this matter?

    My view is that JDs have to win. If they capitulate JDs will increasingly walk away and then it will be the same onerous contracts that will be forced on GPs, Consultants, Nurses, Porters.. Quite frankly all of us are already being forced to work far harder than at any time in the past. If this deteriorates no doctor will be able to mentally cope with full time work in the NHS. Many already can't and only work part-time.

    So despite possibly losing public support This is the only way to go.

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  • Our biggest problem is that Doctors have little support from any Politicians, and that includes the Labour Party. Osborne had to rapidly back down from proposed cuts to the disabled because many Politicians, including Tories, opposed them. Few Politicians support Doctors. They want us to have huge reductions in income. If everyone gets a 30% reduction it is expected that 30% more activity will be achieved.

    So will you accept a 30% reduction in income or are you mentally able to carry out 30% more work as will be forced on us all?

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