United Kingdom: Junior hospital doctors dispute

Following negotiations in May, a revised contract was put before junior doctors in a referendum vote in June, with 58% voting against it. However, the new contract will be introduced from this autumn as originally planned, and medical organisations are concerned that this will exacerbate the NHS’s worsening medical staffing problems.

Following the four strikes by junior doctors in England between January and March of this year, the Health Secretary announced in April that the Government would impose the contract from August onwards.   This was followed by two legal challenges: one from the British Medical Association (BMA), which issued proceedings for a judicial review of the contract on equality grounds and the other from the NHS staff campaign group, Just Health, on the grounds that the contract imposition process did not allow time for adequate consultation.  Furthermore, the doctors responded to the intended imposition by staging an all-out strike on 26 and 27 April, withdrawing emergency cover for the first time.

However, new talks began on 9 May, following a plea by the Academy of Medical Royal Colleges for a five-day cessation of action in order to allow for time-limited, fresh discussions. As such, the BMA, NHS Employers and the Department of Health re-entered negotiations, which were overseen by the independent Advisory, Conciliation and Arbitration Service (ACAS).  The negotiations were then extended on 13 May.  On 18 May, ACAS announced that the parties had resolved the ‘outstanding issues taken forward from previous discussions, finalised and confirmed areas already agreed, and developed further measures which address the wider concerns of junior doctors.’ The ACAS statement contained the revised agreement and this was also communicated by the Health Secretary in a speech to Parliament on 19 May.

According to the BMA, the key improvements include: 


• pay protection for those switching specialities and in the transitional period;
• recognition of junior doctors’ work and contribution across every day of the week, including new allowances for weekends, nights and for work done while on-call and the enshrined principle of ‘pay for all work done’;

• proper consideration of and provision for equality in the contract, with concrete support, including targeted accelerated training and pay protection for parents and carers;

• improved flexible pay premia for specialities — such as A&E and psychiatry — to address the current recruitment and retention crisis in these areas; and

• more rigorous oversight of the new 'guardian' role to ensure safe working for junior doctors.

The final terms and conditions of service for junior doctors in England were released by NHS Employers on 16 June, and members voted on whether to accept these in a referendum that closed on 1 July.  If accepted, the new contracts would have been introduced in stages for different grades and specialities from October. However, on 5 July, it was announced that the doctors had voted to reject the government’s final offer on their new contract.  About 37,000 BMA members, or 68% of the 54,000 trainee doctors and final and penultimate-year medical students who were eligible to vote, took part in the ballot.  58% of these voted to reject the deal.

The chair of the BMA’s junior doctors committee (JDC), who had recommended the deal as the best settlement junior doctors could get, resigned from his position after the results were announced. The Health Secretary, Jeremy Hunt, said that the outcome was 'extremely disappointing' and sought to portray the result as undemocratic.  He gave no indication of what he would do next but Whitehall sources indicated that junior doctors would start being moved on to the new contract from this autumn as originally planned, despite the outcome of the vote. However, medical organisations are concerned that imposing the terms and conditions will exacerbate the NHS’s worsening medical staffing problems.