Non-urgent services will be cancelled on three days in December after 98% of medics back action in BMA ballot

The NHS is about to be hit by a wave of strikes after junior doctors voted overwhelmingly to walk out in protest at the government’s decision to impose a contract on them that they regard as unfair and unsafe.

In a ballot of more than 37,000 junior doctors in England, organised by the British Medical Association, 98% have voted in favour of full strike action. Ninety-nine per cent voted for action short of a strike.

The decision means that non-urgent services in many hospitals, such as planned operations and outpatient clinics, will have to be cancelled on the three strike days announced so far – 1, 8 and 16 December – as many of the NHS’s 45,000 trainee doctors take action.

'The truth is we have no choice': junior doctors on striking Read more

Junior doctors – all medics below the level of a consultant – last took strike action 40 years ago, in November 1975, also over a new contract they claimed would lead to them working dangerously long hours.



Dr Mark Porter, chair of the BMA council, said: “We regret the inevitable disruption that this will cause but it is the government’s adamant insistence on imposing a contract that is unsafe for patients in the future, and unfair for doctors now and in the future, that has brought us to this point.

“Patients are doctors’ first priority, which is why, even with such a resounding mandate, we are keen to avert the need for industrial action, which is why we have approached Acas to offer conciliatory talks with the health secretary and NHS Employers to clarify the conflicting information coming from government over the past weeks.”

Jeremy Hunt, the health secretary, has previously condemned junior doctors for considering a strike and warned that patient care will suffer. “Threatening extreme action is totally unwarranted and will harm vulnerable patients,” he has said. “Refusing to talk to a government that wants to improve weekend care for patients.”



However, Dr Johann Malawana, the chair of the BMA’s junior doctors committee, has maintained that the medics he represents have been forced into contemplating a strike because of what they say has been Hunt’s intransigence. His tactics have caused concern in the senior ranks of the medical profession.



Negotiations between the BMA and the Department of Health and NHS Employers over the contract broke down last year. Strike action has become ever more likely since Hunt announced on 15 September that he intended to impose revised terms and conditions on all junior doctors from next August.

His threat triggered a huge wave of anger among the 45,000 medics affected which has led to an increasingly bitter war of words between the two sides and, despite many medical organisations calling for talks to resume, to the endorsement of a strike. An estimated 20,000 junior doctors attended a protest rally in London last month.



The strike decision shows that Hunt’s two improved offers to junior doctors in recent weeks have done little to persuade them to accept his terms, including an 11% rise in their basic pay, though not in the overtime that many currently rely on to make up as much as 40% of their income.



The Academy of Medical Royal Colleges, which represents all the UK’s 250,000 doctors professionally, said: “The academy is urging both sides in the current dispute around junior doctors’ contracts to step back from the brink and re-enter negotiations in good faith so that an agreement can be reached. Failure to do so will have an adverse impact on the NHS and current and future patients.”



Facebook Twitter Pinterest The Let’s Save the NHS rally and march in London last month, attended by an estimated 20,000 junior doctors. Photograph: Anthony Devlin/PA

The Society for Acute Medicine, which represents hospital doctors that look after very unwell patients who have just been admitted from A&E, believes Hunt’s offer to junior doctors is inadequate and warned “there is never a winner when it comes to strike action”, saying that the dispute threatens to exacerbate the doctor shortages many parts of the NHS are already facing

Dr Mark Holland, its president, urged both sides to urgently resume negotiations over a new contract. “Junior doctors deserve a deal that is fair and reflects their dedication and we remain committed to that because we need the most talented people to join our acute specialties, especially acute medicine. In particular, we would again highlight the need for NHS Employers to recognise that acute medicine is a 24-hour service and the contract for junior doctors working in our specialty must reflect this,” said Holland.

Hunt wants junior doctors to become more flexible in their working patterns to help deliver the fully seven-day NHS that the Conservatives pledged in the general election and which has become one of their priorities for government. He wants to extend the times of the week known as “plain time”, in which junior doctors are paid only basic rates for working, from the current 7am-7pm Monday to Friday to 7am-10pm on weekdays and from 7am until 7pm on Saturdays. Doctors are worried many of them will lose out financially under the system Hunt plans to impose, despite his assurances that none of them will be worse off.

NHS bosses and many heads of medical royal colleges are worried that the timing of the walkouts – just as the health service is entering its busiest time of year – could make it even harder for hospitals to meet waiting time targets for A&E, cancer and planned operations.



They fear elective operations cancelled on the strike days will swell the already growing waiting list for non-urgent treatment.



Prof Sir Simon Wessely, president of the Royal College of Psychiatrists, said last week that “this dispute may be the start of a long harsh winter”. He noted with concern “the level of anger, frustration and disillusionment that is being felt – unprecedented in my [35-year] career” among junior doctors. The “extraordinary” dispute needs to be resolved as soon as possible, he added, “if we are not to lose the current generation of junior doctors” to other countries or other careers.



Junior doctors, Jeremy Hunt and the facts behind the strike ballot Read more

Several medical royal college presidents who met Hunt two weeks ago at his invitation rejected his suggestion that they individually or collectively publicly warn that strike action could harm patients.



However, the Royal College of Surgeons of England has made clear its view that withdrawal of junior doctors’ labour “would be damaging to all those concerned, both doctors and patients”. Senior figures in the medical profession, even those who support the trainees, privately worry that strike action will lead to a loss of public sympathy for the juniors and, as one said, make Hunt appear reasonable and conciliatory.

Heidi Alexander, the shadow health secretary, called on David Cameron to ask the Advisory, Conciliation and Arbitration Service to get involved to try to settle the dispute and avoid a strike because “trust has fundamentally broken down between the parties”.



Hunt’s handling of the negotiations “has caused widespread concern, not just among junior doctors but also among medical royal colleges and patient groups”, Alexander added. However, the prime minister is unlikely to act on her suggestion.



Following the announcement of the ballot results on Thursday, Hunt said in a statement: “It is regrettable that junior doctors have voted for industrial action which will put patients at risk and see operations cancelled or delayed. We want to ensure patients have the same quality of care across the week, and have put forward a generous offer that increases basic pay by 11% and reduces doctors’ hours.

“We hope junior doctors will consider the impact this action – especially the withdrawal of emergency care – will have on patients and reconsider.”