Junior doctors called off three days of planned strikes that would have seriously disrupted NHS services after a last-minute agreement to hold further talks with Jeremy Hunt to try to agree the details of a new contract.



The dramatic breakthrough in the increasingly bitter dispute arrived only hours before the first strike was due to begin at 8am on Tuesday, which would have left many hospitals in England offering only the very limited range of services usually seen on Christmas Day.

It came following five days of discussions, overseen by the independent Advisory, Conciliation and Arbitration Service (Acas), between the British Medical Association (BMA), NHS Employers and Hunt’s Department of Health (DH).

The BMA agreed to call off walkouts planned for 1, 8 and 16 December after the health secretary finally bowed to their repeated request to drop his longstanding demand – albeit temporarily – to impose a punitive new contract on England’s 45,000 junior doctors if agreement was not reached, largely on terms he had dictated. His stance had sparked huge anger among the affected doctors in training, 98% of whom voted for strike action in protest.

However, an estimated 20,000 patients will not have non-urgent operations that were planned for Tuesday, such as cataract and skin lesion removals and hip and knee replacements, as the decision – announced at 7.05pm on Monday evening – came too late. They will have their procedures rescheduled.

An Acas spokesman said: “Following five days of productive talks under the auspices of Acas, the BMA, NHS Employers and the Department of Health have reached an agreement. Acas is pleased that the talks have been held in a constructive manner and cooperative spirit between the parties, that will allow an improvement in industrial relations.”

A detailed memorandum of understanding, which the three parties agreed, makes plain that agreement over junior doctors’ new terms and conditions must be reached “without undue delay”.

It makes clear that both sides – especially Hunt – have moved away from previously-held fixed positions over issues such as pay, working hours and how to ensure patient safety.

“Nobody wanted to see industrial action, not least the junior doctors, so it will be a huge relief to many that common sense has finally prevailed,” said Heidi Alexander, the shadow health secretary.

She blamed Hunt for the cancellation of so many operations and outpatient clinics on Tuesday by leaving it so late before he stopped insisting on his right to impose a contract if he was not happy with the outcome of discussions about the detail of the new contract – due to come into force in August 2016.

Relations between the BMA and Hunt had become ever more acrimonious in recent weeks since he first issued his threat of imposition on 15 September. Substantial talks became impossible because he would not retract his threat and the BMA refused to talk unless he did.

The memorandum of understanding states that the BMA, NHS Employers and DH “are all agreed that a return to direct and meaningful negotiations in relation to a new contract for junior doctors is the right way forward. We intend to reach a collaborative agreement, working in partnership to produce a new contract for junior doctors, recognising their central role in patient care and the future of the NHS.

“All sides wish to achieve a contractual framework that provides fair reward and a safe working environment for junior doctors throughout the working week”.

The three organisations now have until 13 January to try to bridge the often big gap between them on a range of issues. The 37,000 junior doctors who belong to the BMA could still strike after that if the union’s junior doctors committee is unhappy with any deal that emerges.

“NHS Employers have agreed to extend the timeframe for the BMA to commence any industrial action by four weeks to 13 January at 17.00, to allow negotiations to progress.

“Within that timetable, the BMA agrees to temporarily suspend its strike action and the Department of Health agrees similarly to temporarily suspend implementation of a contract without agreement,” the document added.

The parties agreed that Hunt’s second, most recent offer to the junior doctors – all medics below the level of consultant – “is the basis for further negotiation”.

On the key issue of which hours in the week doctors get paid at their basic rate or overtime for working – one of the biggest areas of disagreement – the memorandum of understanding suggests that negotiations will in effect go back to the drawing board. Hunt has been seeking to extend “plain time”, the hours in which a trainee doctor receives standard pay, from 7am-7pm Monday to Friday to 7am-10pm every day except Sunday, though he later offered to make it 7pm on a Saturday.

The parties have agreed to “define propositions on work schedules, including the number of hours designated as plain time, ensuring that doctors in training would not be expected to work consecutive weekends, and how time for administrative duties and training should be recognised.”

The deal to avert the strikes states that a new way will be found to ensure that junior doctors do not end up working dangerously long hours – another key area of concern for the BMA. It had rejected Hunt’s suggestion of scrapping existing safeguards and instead giving the Care Quality Commission, the NHS care regulator, key oversight on that.

“Contractual safeguards for safety are paramount and we therefore commit to develop a jointly selected and supported guardian role to oversee the hours of work of doctors in training and ensuring appropriate payment for hours worked outside planned work schedules”, it says.

Hunt, whose handling of the dispute caused huge concern in the NHS and medical establishment, may now face questions over why he took so long to, in effect, stage a climbdown.

“If Jeremy Hunt had agreed to independent talks when it was first put to him he could have avoided or at least mitigated any disruption to patients tomorrow. Unfortunately, it will now be too late to rearrange the operations and appointments that have been cancelled and those patients deserve an apology from Jeremy Hunt,” said Alexander.