The Number of Medical School Places will Increase by 25% from 2018

Health Secretary Jeremy Hunt has announced that the number of medical school places available to attract young doctors will increase by 25% from 2018.

The intention is to ensure that England can be completely self-sufficient in training doctors following the recent decision to Brexit from the EU.

In alignment with this goal, trading places will be increased from 6,000 to 7,500 on an annual basis.

It is hoped that the number of homegrown doctors will also play a role in addressing the inevitably greying population.

But Prime Minister Theresa May has already commented that the Conservative party wishes to see the NHS recruit doctors from within the UK as much as possible.

Considering the difficult relationship that the government currently has with junior doctors, it may also be thought that extra recruitment is required to deal with professionals moving overseas.

It is also becoming increasingly difficult to attract talented young people to the medical profession.

Indeed, the latest figures from Health Education England show one in 10 education places remain unfilled.

The biggest gaps are seen in psychiatry (19%), GPs (17%) and paediatrics (7%).

But Hunt told the Conservative Party conference in Birmingham on Tuesday that putting provisions in place for the NHS of the future is essential.

“We need to prepare the NHS for the future, which means doing something we have never done properly before – training enough doctors. Currently a quarter of our doctors come from overseas. They do a fantastic job and we have been clear that we want EU nationals who are already here to stay post-Brexit. But is it right to import doctors from poorer countries that need them while turning away bright home graduates desperate to study medicine?”

Despite the £100 million of investment in training places announced by the government, many healthcare leaders and experts are unconvinced that this is satisfactory.

British Medical Association leader Dr Mark Porter suggested that the announcement “falls far short of what is needed”.

Porter went on to criticise the role of the government in what he sees as a declining NHS system.

“The government’s poor workforce planning has meant that the health service is currently facing huge and predictable staff shortages. We desperately need more doctors, particularly with the government plans for further seven-day services, but it will take a decade for extra places at medical school to produce more doctors. This initiative will not stop the NHS from needing to recruit overseas staff.”

Nigel Edwards, chief executive of the Nuffield Trust, largely concurred with this verdict.

“For decades, the NHS has failed to train enough of its own staff, so increasing the number of UK-trained medical staff is long overdue. However, if this new announcement involves simply replacing overseas doctors with UK-trained ones, that won’t increase the total number working in the NHS, and certainly won’t solve the agency staff crisis that is affecting the NHS right now.”

Currently approximately one-quarter of the NHS medical workforce is trained outside the UK.

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GPC to Inform LMCs on Industrial Action Imminently

The GPC has indicated that it intends to contact LMCs as early as next week regarding decisions on whether or not to ballot doctors on potential mass resignations.

This revolutionary and controversial action will reach its three-month deadline at the end of next week.

Commenting on the issue, GPC deputy chair Dr Richard Vautrey indicated that action must be taken imminently if the issue is to be resolved satisfactorily.

“The timeframe for the motion is imminent. It is around 20 August [based on the conference motion timeframe]. It has obviously been discussed quite significantly within the GPC, and we have had a lot of engagement with NHS England since the conference itself. We are putting together a statement which we will be issuing shortly, relating to all these issues.”

The conference motion had declared LMCs did not accept that the GP Forward View was “an adequate response to the crisis in general practice and considers it to be sufficient grounds for a trade dispute”.

Numerous measures have been requested from NHS England, including setting a maximum limit on the number of patients GPs are required to attend to in a single day.

It is also requested that a nationally defined contract for GPs employed by other providers should be agreed.

The May LMC Conference motions in full are listed below:

AGENDA COMMITTEE to be proposed by Tower Hamlets: That conference does not accept the General Practice Forward View is an adequate response to the GPCs statement of need within the BMAs Urgent Prescription for General Practice, and considering this to be sufficient grounds for a trade dispute, unless the government agrees to accept the Urgent Prescription within 3 months of this conference, the GPC should ask the BMA to:

(i) ballot the profession on their willingness to sign undated resignations CARRIED

(ii) ballot the profession on their willingness to take industrial action CARRIED

(iii) ballot the profession as to what forms of industrial action they are prepared to take CARRIED

(iv) produce a report to practices on the options for taking industrial action that doesn’t breach their contracts CARRIED

AGENDA COMMITTEE to be proposed by Cambridgeshire: That conference with regards to the General Practice Forward View;

(i) Welcomes the acknowledgment of significant past underfunding and commitment to increased spending CARRIED

(ii) believes that most of the investment promised is conditional upon practices delivering transformation and service change CARRIED

(iii) recognises that only some of the demands of the profession have been included, and instructs GPC to continue to press for further dedicated resources to support GPs CARRIED

(iv) does not believe that there is sufficient urgency in the measures described CARRIED

(v) is concerned that the present financial state of the NHS makes the prospects of these financial flows unlikely CARRIED

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Junior Doctors Committee to Call for Further Junior Doctor Industrial Action

The Junior Doctors Committee (JDC) of the British medical Association has called on the union to authorise further strike action as the ongoing row over contract continues.

The full council will be asked to support industrial action from early September, as healthcare professionals continue to play hardball with the government and authorities.

In response to the contractual terms offered to junior doctors, the JDC suggests that concerns that the organisation has expressed have not been satisfactorily addressed.

The contract was rejected by 58% of its members who voted in the ballot.

In a letter to members, Dr Ellen McCourt, who chairs the JDC, said the government had remained “persistently silent” on issues which, she said, had resulted in the contract being rejected.

“In light of this, the JDC Executive has voted to reject the proposed new contract in full and to call for formal re-negotiations on all of your concerns. In response to the government’s silence, JDC exec has today made a formal request for a special meeting of BMA Council to authorise a rolling programme of escalated industrial action beginning in early September.”

But Daniel Mortimer, chief executive of NHS Employers, was scathing on at the prospect of further industrial action, and its alleged impact on the health service.

Mortimer suggested that strikes “would achieve little or nothing, but place pressure on already stretched teams and services and causes worry, distress and disruption for patients, carers and their families”.

Many physicians and healthcare professionals will doubtless disagree with this stance, considering it to be something of a guilt trip.

Nonetheless, Mortimer suggested that during the past two months that dialogue had been taking place with the Junior Doctors Committee, and NHS Employers has “responded positively to concerns regarding the guardian role and whistleblowing”.

And the chief executive suggested that the conduct of the authorities was indicative of how seriously they took the contract and concerns of healthcare employees.

“Employers were hopeful that the continued positive engagement on other important topics… were a sign of how serious employers, Health Education England and the Department of Health were about honouring the agreements reached with the BMA.”

With six strikes having already occurred over the matter, including the first total walkout in the history of the NHS, there is no doubt that both sides would prefer to avoid further industrial action.

The BMA’s junior doctor leader, Dr Johann Malawana, has already resigned as a consequence of the BMA supporting the contract, which was later rejected by ballot.

Health Secretary Jeremy Hunt has insisted that the contract will be imposed on medics in England.

But it seems that this story has more mileage to run in the meantime.

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Judicial Review to be Conducted into Junior Doctors’ Contract Imposition

A judicial review into the imposition of the junior doctors’ contract will be held in September, after a campaign group successfully argued the case to be within the public interest in court.

Justice for Health manage to raise £120,000 to cover unanticipated court costs, and successfully convinced a High Court judge that a full, expedited judicial review is a necessity.

The campaign group was established by five junior doctors, including two trainee GPs, and argued that the Health Secretary does not have sufficient power to impose such a contract and its resulting conditions on junior doctors.

Justice for Health has urged self secretary Jeremy Hunt to make crystal clear whether he intends to adopt the new contract via NHS trusts, or actually physically impose it on junior doctors.

Although no explicit date has been set for the case, it is expected to convene in September, with the junior doctors’ contract due to commence one month later.

Health Secretary Hunt indicated his intention to impose the contract on junior doctors earlier this month, after British Medical Association-backed conditions were rejected by an open referendum.

But despite the intentions of the Cabinet Minister, it now seems doubtful that it will be legally possible for the contract to indeed be imposed.

Doubts had previously mulled over whether it would be possible for the case to continue, following financial difficulties for the Justice for Health team.

Department of Health lawyers made what some have considered to be an unreasonable move, requesting additional security costs on Wednesday, just 24 hours before a case management hearing to determine the case was to proceed.

But the group was able to raise the sum in an emergency crowdfunding campaign, eventually securing the legal results that they desired.

Justice for Health commented favourably on the news in a statement, indicating their hopes that the junior doctors contract imposition could be overturned.

“Today we have had a good day in the High Court challenging Mr Hunt’s position on imposition, the judge has heard our initial proposals and granted us a full, expedited judicial review hearing expected in September. The judge remarked that this is an important case that has merit and needs to be heard in the public interest.”

Health secretary Jeremy Hunt has previously confirmed that foundation trusts have the technical powers to determine their own staff pay and conditions.

But he told MPs earlier this year that collective bargaining would be key to this process going forward.

“The reality within the NHS is that we have a strong tradition of collective bargaining, so in practice trusts opt to use national contracts. As the secretary of state is entitled to do, I have approved the terms of the national contract.”

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Junior Doctors to Stage Full Walkout for the First Time

As had been widely predicted, junior doctors under the auspices of the British Medical Association will escalate strike action, and stage a full walkout.

The action has been taken as the ongoing row with the government over pay and conditions continues to rumble.

Health Secretary Jeremy Hunt has repeatedly threatened to impose the contractual conditions on junior doctors, but with public support and industrial action both intensifying, this hardball approach seems increasingly unwise and unrealistic.

The British Medical Association stated an all out stoppage would take place in which emergency care was not provided, as increasingly severe industrial action is taken in order to counter the intransigent government position.

Junior doctors have provided emergency care during previous strikes, with the government refusing to budge on the subject, and it is clear that NHS staff feel they have no choice in the matter.

Medics believe that the changes proposed by Hunt will incentivise unsafe shift patterns, putting patients’ safety and lives and risk. The Health Secretary says the change will help deliver better care at weekends.

And with the public continuing to back the doctors in the dispute and oppose the position of the government, Hunt will be aware that he faces a very difficult situation in this matter.

Speaking ahead of the proposed industrial action, BMA junior doctor leader Dr Johann Malawana indicated that the members of the doctors’ union are by no means enthusiastic about the walkout, but feel that the government position has simply necessitated it.

“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.”

Opposing the position of the junior doctors, the government claimed that the move was desperate and irresponsible, and there was some support for this from polling agencies.

Anna Quigley, head of health research at pollsters Ipsos MORI, believed that the full walkout is essentially a risky strategy, and one that could turn public opinion against junior doctors.

“Each step of the way with these strikes, we’ve taken the pulse of public opinion and found the majority of people support the Junior Doctors even as the action has rolled on from month to month with little hope of swift resolution. However, if emergency care is not provided during strikes the public is much less likely to support them. With this new expanded raft of action, junior doctors may risk their solid base of public support and with that, a powerful bargaining tool.”

The walkout will be the first in NHS history, and is planned between the hours of 8am and 5pm on Tuesday 26th and Wednesday 27th April.

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Third Junior Doctors’ Strike Underway

The third junior doctors’ strike in relatively quick succession began today, as NHS employees continue their protest against contractual conditions being proposed by the government.

Public support for this industrial action continues to grow, as the Health Secretary, Jeremy Hunt, threatens to force the protesters to accept the conditions proffered.

This 48-hour walkout represents a further escalation in the ongoing dispute between the government, the British Medical Association and the doctors themselves.

It is clear that there is still considerable ground between the position of the government and junior doctors, and little prospect of an immediate brokering of an agreement.

Previous industrial action lasted half the length of this particular strike, yet public sympathy at picket lines remained strong.

A poll for the BBC showed that 65% support the industrial action, almost identical to the backing before the previous strike last month.

And the percentage opposing the strike has also fallen significantly, differing from 22% last month, to 17% in the most recent survey.

It is quite evident that the position of Jeremy Hunt, and his threats to impose the contract against the will of the BMA and junior doctors, is looking to be increasingly tenuous.

In addition to the new contractual terms, it is also believed that the desire of the government to create a so-called seven-day NHS culture is simply incompatible with the plans.

The BMA states the changes would increase the burden on its members and thereby compromise patient safety.

And Holmes has been strongly attacked by the Labour party in parliament for offering a statement on patient safety in the Commons, while neglecting to mention the strike even once.

Shadow health secretary, Heidi Alexander, commented: “How can he stand here and talk about patient safety when it’s him and him alone to blame for the current industrial action, for the destruction of staff morale and for the potential exodus of junior doctors to the southern hemisphere?”

Hunt responded by suggesting that the Labour Party is backing the British Medical Association against the needs of patients, a view that has been strongly criticised by doctors participating in the strike action.

Dr Anne Rainsberry, national incident director for NHS England, apologised to patients for the strike, emphasising that the health service would be tested.

“Unfortunately the cumulative effect of these recurring strikes is causing disruption to thousands of patients, for which we can only apologise. A 48-hour stoppage puts considerably more pressure on the NHS. The impact of the action so far is broadly in line with what we were expecting but we know that the second day is going to be more difficult and have made sure plans are in place to respond to any rising pressures.”

But at picket lines, doctors stated that their primary concern is the welfare of patients, and that the new contract would simply compromise this.

Two further 48-hour strikes are planned for next month.

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Junior Doctors’ Contract Row Set to Become ‘War’

A leading union has stated that the dispute over junior doctors’ contracts could yet become a war between NHS staff.

Unison’s Christina McAnea said imposing the contract “sends a very worrying message to other members of staff”.

McAnea added that “everybody else is really worried that if they can do this to doctors, what does that mean for us?”

Health secretary Jeremy Hunt has insisted that he will impose what he considers to be ideal contractual provisions for junior doctors, but these plans increasingly seem to be unravelling.

It is already been reported that individual hospitals will have the right to overrule Hunt, and now major unions are suggesting that a civil war is essentially brewing in the NHS.

Yet he remains defiant on his position with regard to junior doctors’ contracts.

The Health Secretary claims that the contractual plans that he has will improve patient care, and Hunt has also stated that he has made efforts to listen to the concerns of healthcare professionals.

Hunt has also publicly criticised the British Medical Association, suggesting that the organisation has been intransigent in failing to reach a deal over the past three years.

But the walkout of junior doctors recently indicates that NHS staff are willing to play hardball with the government and establishment.

Meanwhile, the aforementioned McAnea believes that ill feeling is brewing in the health service, and that this could have very serious consequences.

“Our feeling is the government wants to extend seven-day services but they don’t want to fund it. They want staff to fund it through accepting cuts to pay and conditions. If there is a cut to unsocial hours payments or an imposition [of a new contract] then I think they would look to take some kind of action.”

Increasingly, public feeling it seems to be with junior doctors, with a petition on the subject having raised 180,000 signatures.

This exceeds the thresholds for a Commons debate by over 100,000, indicating the strength of feeling, and also the fact that the political process will have to acknowledge this fissure.

It is suggested that many junior doctors may consider venturing abroad in order to ply their trade, with contractual conditions threatening some junior doctors’ pay to be reduced by as much as 30%.

With neither side seemingly willing to back down, and still a considerable distance between the two parties, this certainly seems like an issue that will continue to run into 2016.

As the Health Secretary currently faces numerous problems within the NHS, it could be that he is ultimately forced to back down significantly and embarrassingly over this issue.

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Hospitals May Overrule Hunt on Junior Doctors’ Contracts

Reports are indicating that hospitals may ignore the action of Health Secretary Jeremy Hunt in relation to junior doctors’ contracts.

Holland has threatened to impose the contractual conditions that have proved to be such a bone of contention, but it seems that hospitals may refuse to impose these contracts.

None of the 152 foundation trust hospitals in England will be obliged to force their junior doctors to accept the deal and can instead offer them better terms.

This provides the potential for health institutions across the UK to completely blindside the plans of the Health Secretary, in a move that would be extremely well received by junior doctors and other supportive health professionals.

Responding to the newly revealed loophole, the Labour party suggested that the position of the government is becoming untenable.

“Jeremy Hunt’s decision to impose the junior doctors’ contract seems to be unravelling with every day that goes by. The fact that hospitals are trying to find ways around contract imposition underlines the extent to which the decision to impose a contract that nobody wants would destroy morale in the NHS,” said the shadow Health Secretary, Heidi Alexander.

Even some members of the Conservative party have criticised the policy of the Health Secretary.

Dr Dan Poulter MP, who was a health minister until last May, commented that the decision made by Hunt regarding the imposition of the contract represented “a dark day for the NHS and the future of medicine”.

The Department of Health has already responded to media reports, indicating that it is indeed accurate that foundation trusts which are semi-independent of NHS control cannot be compelled to enforce any contract.

“Foundation trusts are not mandated to bring in the new contract. They can negotiate locally. However, [non-foundation] trusts are [obliged to use Hunt’s contract],” a spokesman affirmed.

Increasingly, it seems that the plans of Hunt are completely unworkable, and opposition to the imposition of the contract in particular is growing.

Hunt had claimed in the Commons that a raft of senior NHS leaders back his decision to impose the contract, but this soon unravelled under further examination.

A letter of support signed by numerous prominent individuals has since been disowned by 13 of the 20 supposedly signatories.

Hunt maintains that enforcing the contract is necessary in order to let hospital bosses recruit more junior doctors to work at weekends and usher in the so-called seven-day NHS.

But junior doctors fighting against what they consider to be unfair conditions looks to have increasingly encouraging prospects.

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Junior Doctors Strike to Go Ahead After Talks Break Down

The planned strike by junior doctors will go ahead as talks with the government have failed to broker an acceptable agreement.

But union leaders have indicated that medics intend to provide emergency cover as they come under public pressure regarding the safety and health of the public.

This represents something of a compromise considering that the 10th February action was originally intended to be a full walkout.

However, the British Medical Association has now indicated its intention to minimise the impact of industrial action, possibly with the intention of currying favour with the public.

With polls indicating that the general populace is becoming favourable to the cause of junior doctors, it is perhaps felt by the British Medical Association that opinion is already being swayed in its favour.

Conversely, considering the decision regarding the walkouts, the British Medical Association has decided to take other measures instead.

Thus, the strike will last 24 hours in total, as opposed to the nine hours that were originally planned.

A full walkout has never happened before in the history of the NHS and would have led to a mass cancellation of routine treatments, such as knee and hip replacements, as consultants and other staff were redeployed to cover behind the junior doctors.

Commenting on the issue, BMA junior doctor leader Dr Johann Malawana indicated that some progress had been made, but that the government continues to take an entrenched position on cutting Saturday pay.

“What we are asking for is fair and affordable recognition of unsocial hours,” Malawana stated.

Malawana added that the union was hugely regretful of the disruption being caused by strike action, but that it was necessary in the context of the ongoing row.

While the government has made concessions, it still wants 7am to 5pm to be classed as normal working hours, therefore attracting no extra pay.

Although it is thought that the two sides are coming closer to a compromise, despite the strike action, this unsociable hours issue remains completely unacceptable to the British Medical Association.

Responding to the claims of the union, a spokeswoman on behalf of the Department of Health was keen to emphasise concessions that had been made over the last few weeks.

In particular, guarantees regarding the number of weekends doctors would have to work, and a more generous offer regarding extra payments for Saturday work were cited.

The spokeswoman stated that these new agreements were indicative of the strong desire of the government to reach a deal, and that “it is regrettable that the BMA is proceeding with further unnecessary industrial action.”

With the two sides stubbornly sticking to their guns, resolution of the issue may still be some distance into the future.

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Poll Shows that Public Support for Junior Doctors is Growing

A major opinion poll has suggested that public support for junior doctors has grown since the first industrial action was taken by NHS workers.

Junior doctors took strike action over pay and working hours earlier this month, and further strike action is planned for February.

And despite a series of talks between junior doctors, the British Medical Association and the government, there has been no agreement brokered on the issues as of yet.

Thousands of medical staff were involved in the action against health secretary Jeremy Hunt’s proposed changes to junior doctors’ contracts.

Yet a survey conducted by Opinium, during and immediately after the strike on 12th January, will at least be encouraging for junior doctors in terms of the public perception of the issue.

The survey indicated that 53% of the public believe that strike action is justified, with only 21% indicating that it is not.

This compares with a poll in October that found that 41% were in support of action with 26% against.

In what can be seen as a microcosm of the existing political situation, the demarcation between Conservative and Labour supporters was particularly marked.

The proportion of Conservative voters who said they thought the strikes were justified rose slightly from 27% in October to 36% in the latest survey, while backing among Labour voters grew more sharply, from 54% to 76%.

Of those who thought the strikes were justified, 72% said this was because “doctors already work long enough hours”, while 67% said “more doctors are needed rather than changes in hours”.

And it is also notable that there are concerns about the general public with regard to the safety of NHS patients.

Nearly half of those that supported the strikes indicated that they believed the changes proposed would be unsafe for those being treated by the NHS.

Another 39% believed that junior doctors are already underpaid for the demanding work that they are required to conduct.

Of those who still think the strikes are unjustified, just under three-quarters (74%) agreed with the statement that “other workers have to accept unsociable working hours”; 69% believed that “weekend and weekday NHS coverage should be the same”, the same proportion as thought that “doctors choose to do a job with unsocial hours anyway”.

The figures indicate that despite the fact that the medical profession is viewed as somewhat attractive and prestigious, there is still broad public support for the position and case of the junior doctors.

Opinium Research carried out an online survey of 2,003 UK adults from 12 to 14 January 2016

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Talks Ongoing as Further Junior Doctors Strikes Looming

Talks aimed at averting strikes in the continuing conflict over junior doctors’ contracts are continuing.

The government has warned the complainants that it could impose its controversial new contract on junior doctors.

With employees in the health service continuing to oppose the government position, it seems that talks are still somewhat deadlocked.

Meanwhile, the British Medical Association (BMA) and the government have begun a planned two days of talks, according to the conciliation service ACAS.

The new contract has been particularly controversial owing to elements related to pay and career progression.

In particular, it has been suggested that as a result of the government redefining the notion of off-peak hours that some junior doctors’ pay could be reduced by as much as 30 per cent.

The government had suggested prior to the recent strike that the two sides were close to an agreement, but a spokesperson on behalf of the BMA disagreed strongly.

It was indicated that there were as many as sixteen different areas of disagreement between the union and government, and thus talks clearly have some way to go in order to broker a satisfactory impasse.

Junior doctors returned to work at 08:00 GMT on Wednesday following the end of their first 24-hour walkout, which led to the cancellation of about 3,300 operations.

Talks are intended to alleviate two further strikes, with the first planned for 26th January, and the second, on 10th February involving a refusal to take part in emergency care.

Commenting on the issue, BMA council chairman Dr Mark Porter, indicated that there is still significant disagreement between the two parties, and “not just one remaining issue” as had been suggested by Health Secretary Jeremy Hunt.

Porter stated that “there are some serious issues about patient safety and recognition of junior doctors’ contributions that need to be sorted here.”

With the issue causing serious discord, the government has signalled its intention to address the concerns of doctors.

The government’s new head negotiator, Sir David Dalton, outlined his determination to “engage with the BMA team directly and listen to their outstanding concerns”.

Yet despite the conciliatory tone, it seems that the government is reserving the right to utilise the so-called ‘nuclear option’.

It has been widely reported that the government will impose the contractual conditions on junior doctors if no adequate agreement can be found.

Ministers offered doctors an 11% rise in basic pay last year, but that was offset by curbs to other elements of the pay package, including payments for unsociable hours – they have maintained there is not extra money for junior doctor pay.

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Strike Action to go Ahead as Junior Doctors Talks Collapse

Despite eleventh hour talks, mooted strikes from junior doctors are set to go ahead.

The British Medical Association has announced that talks with government have failed to broker a satisfactory agreement, and doctors will now participate in the strike action next Tuesday.

Representatives from the BMA, NHS Employers and the Department of Health have been locked in talks to find a settlement over a new contract since mid-September.

A final offer was proffered to the 45,000 junior doctors based in the UK on Monday, as talks aimed to find a settlement satisfactory for all parties.

Yet the protracted disputes could not be settled in adequate fashion, and now junior doctors will go on strike next week.

Junior doctors will stage their first walkout on 13 January and only provide cover for medical emergencies in areas such as A&E and emergency surgery, possibly for 24 hours.

This is likely to be followed by two further days of industrial action in which they do not work at all between 9am and 5pm.

Junior doctors are dissatisfied with the changes that the government is proposing to their existing contractual terms.

This would result in the definition of what can be considered off-peak hours changing, and junior doctors argued that this will have a significant impact over their earning potential.

Under the new contract, some junior doctors may lose as much as 30 per cent of their annual pay.

The government had indicated some willingness to shift toward the position of junior doctors, but evidently this has been insufficient to satisfactorily resolve the dispute.

Monday was the deadline the BMA had given for ministers to give significant ground on key issues or face a coordinated series of strikes, starting next week, just as the NHS is coming under its heaviest winter pressures.

The dispute over junior doctors’ contracts is but one of several prominent and serious issues in the NHS that is causing unrest.

Government plans to alter the contracts of the junior doctors is indeed indicative of the financial malaise that the NHS is facing.

With £22 billion pounds of efficiency savings needing to be made by the end of the decade, it is clear that the decision to alter junior doctors contract is motivated by fiscal concerns.

The basis for the latest round of negotiations on this matter has been the government’s offer from early November which includes an 11 per cent rise in basic pay for junior doctors.

But this plan is offset by plans to cut the number of hours on a weekend that junior doctors can claim extra pay for “unsocial” hours.

The government has robustly defended its position, but it seems that junior doctors are holding firm against what they consider to be unreasonable demands.

Some 98 per cent of junior doctors balloted by the BMA voted in favour of strikes.

The full walkout will be a unique event in the history of the NHS.

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