Jeremy Hunt has condemned what he described as “extreme action” after the British Medical Association (BMA) said junior doctors would take strike action on three days in December.

The health secretary is gearing up for a fierce battle with the profession, despite NHS bosses and leaders of the medical profession warning him that a protracted dispute will seriously disrupt services just when they are under the most pressure.

The BMA said junior doctors would walk out on 1, 8 and 16 December over a new contract Hunt is threatening to impose on them if, as expected, their ongoing ballot approves industrial action.

“Threatening extreme action is totally unwarranted and will harm vulnerable patients. Refusing to talk to a government that wants to improve weekend care for patients and reduce doctors’ hours can only damage the NHS,” said Hunt on Thursday.

Junior doctors, 20,000 of whom staged a protest march in London last month, are furious that the proposed new contract will hugely extend the hours in any week for which they are paid basic rates of pay – from the current finish-time of 7pm on weekdays to 10pm – and, crucially, will also include Saturday up until teatime for the first time.

They are also worried that safeguards that stop hospitals forcing them to work dangerously long hours, and the current banding system which dictates how much they are paid, especially in overtime, will both disappear.

Hunt has insisted that no junior doctor will lose out financially under the new system, that it will reduce the maximum number of hours they can be expected to work in any week, and that it is essentially to ensure that more doctors are on duty at weekends to help deliver the promised seven-day NHS by 2020.



Hospitals are now bracing themselves for having to cancel thousands of planned operations and outpatient clinics if the BMA’s ballot leads to the walkouts.

Dr Sarah Wollaston, chair of the Commons health select committee and herself a GP, said the industrial action was “far too extreme”, coming in the middle of what is traditionally the busiest period of the year for the NHS.

“I think it is not putting patients first, I think this will be highly unsafe for patients,” she told the BBC Radio 4 Today programme on Friday.

“When you think of the number of procedures that might not be emergencies but are extremely urgent, to have three days, including two of them a full walkout, will be putting patients in significant harm.”

Danny Mortimer, chief executive of NHS Employers, which represents hospitals in relation to staff pay and conditions, said: “We know this will have a huge impact on patient care and we urge the BMA to avoid putting patients and the NHS in this position by returning to talks with us. Proposed strike action as outlined by the BMA would be hugely regrettable.

“Employers across the NHS will be extremely disappointed and anxious about the difficult situation they will find themselves in to make sure work schedules are met and patient care is not compromised,” he added.

The Guardian understands that Hunt has rejected a number of personal, private overtures made to him in recent days to try and reach a compromise with junior doctors’ leaders to avoid a strike. One very senior figure in the NHS has told colleagues that the dispute, which began in September, has been “a total fuck-up from start to finish” that will make things very difficult for hospitals.

Hunt has insisted privately that his aggressive stance has the support of David Cameron and that, if the strikes do happen, he will be seen as reasonable. Privately, though, NHS leaders and senior medics reject Hunt’s view. “He can’t portray junior doctors as being on the golf course or in private practice because they’re junior doctors,” said one.

The minister is thought to believe that he will win the battle for public opinion and that the government cannot afford to be seen to lose such a high-profile industrial dispute.

Hunt said on Thursday the BMA should “put their patients first” by returning to negotiations they walked out of last year. However, his refusal to accept the BMA’s request to drop his preconditions to resuming talks, notably his threat to impose a new contract, means fresh talks are highly unlikely.

The NHS has 45,000 trainee doctors in England, of whom 30,000 belong to the BMA. On the first strike day, they would provide only emergency care for 24 hours starting at 8am on Tuesday 1 December, reducing hospitals to the minimal level of service usually seen on Christmas Day.

They intend to follow that with two all-out stoppages, in which all junior doctors will refuse to work. Those walkouts are expected on Tuesday 8 December and Wednesday 16 December, subject to the result of a ballot by the BMA of the 30,000 juniors it represents.

The ballot closes next Wednesday at 5pm and the result will become public the next day.

The action, if it happens, will see most planned operations and outpatient clinics cancelled, with consultant doctors prioritising more urgent and emergency cases.

The BMA’s leader said junior doctors had been forced into the prospect of withdrawing their labour by the intransigence of ministers over a contract the union insists is unsafe for patients and unfair for doctors.

Dr Mark Porter, chair of the BMA’s ruling council, said: “We are releasing this information at this early stage because we want to give as much notice as possible to minimise disruption to other NHS staff and, above all, to patients.

“Our dispute is with the government and our ballot for industrial action is a last resort in the face of their continued threat to impose a new contract.

“Industrial action is the last resort for a reason: it comes only when every other avenue has been exhausted. The BMA has been explicit in what needs to change in junior doctor contract proposals. The government’s refusal to work with us through genuine negotiations, and its continued threat to impose an unsafe and unfair contract, leaves us with no alternative.”

Dr Mark Holland, president of the Society for Acute Medicine, warned that A&E units are facing a nightmarish scenario that will heap on the pressure in the buildup to winter. He told Sky News that a lack of staff and possible industrial action by junior doctors were very worrying at this time of year, adding there had been a rise in the number of patients needing emergency care. “As chair of a trust, I’m speaking out. The NHS is headed for financial ruin.”



Highlighting the pressures, the NHS in England missed several key targets for A&E admissions, cancer referrals, ambulance response times and NHS 111 calls in September as it braces itself for a busy winter period.

Against a target of 95%, 93.4% of patients attending emergency departments were seen within four hours in September. The figure was 94.3% the previous month. The A&E data for September is often cited as an indicator of pressure on the NHS as it prepares for winter.

Last winter, from the beginning of October to the end of December, 92.6% of patients were seen within four hours, the worst quarterly performance since the target was introduced at the end of 2004. The data, published by NHS England, is for all A&E types, including minor injury units and walk-in centres. It refers to the number discharged, admitted or transferred within four hours of arrival.

NHS England also missed other targets. The 62-day wait for cancer treatment from GP referrals was 81.5% against a target of 85%, the 17th month in a row it has been missed. The 14-day wait for patients with breast cancer symptoms was 92.7% versus 93%, the third month in a row the target has been missed.

Annual numbers for cancer referrals show the NHS continues to miss its targets. The proportion of people waiting no longer than 62 days for a referral has fallen each year since a peak of 87.2% in 2012-13. The figure for 2015-16 to date is 81.9% – 3.1 points below the target.

Ambulance “red 1” critical calls responded to within eight minutes was 72.9%. The target is 75%. It is the fourth month in a row it has been missed. “Red 2” immediately life-threatening calls responded to within eight minutes was 68.9%. The target is 75% and it has not been met since January 2014.

NHS 111 calls answered within 60 seconds was 91.4%. The target is 95%. This was the lowest figure for any month of the year so far.

Responding to the September data, Heidi Alexander, the shadow health secretary, said: “These figures show that the NHS is facing breaking point before winter has even started. It is a stark illustration of just how far the NHS has declined under the Tories. Unless there is an urgent and significant injection of money into the NHS, then standards of care will be compromised this winter.”