Medical director for England says walkout will cause irreparable damage to the profession and its public standing

Junior doctors risk irreparably damaging the trust between the medical profession and the public if they go ahead with their first ever all-out strike, the NHS’s most senior doctor has claimed.

Withdrawing emergency cover crosses a line – it will damage trust in doctors Read more

A total withdrawal of labour, scheduled for later this month, will threaten hospitals’ ability to deliver safe care in areas such as A&E, childbirth and intensive care, according to Prof Sir Bruce Keogh, the national medical director of NHS England.

In a strongly worded article in the Observer, Keogh writes that such an escalation of the dispute with the government would be reckless, unethical, a breach of the medical profession’s fundamental duty to “do no harm” and a move that will destroy the public’s trust in doctors.

“Despite the fact that consultants will do their best to cover, the fact is that junior doctors are key to the safe and effective running of our NHS. So this new action will put additional, significant strain on A&E, intensive care and maternity services, particularly in smaller hospital,” Keogh explains.

“I worry that withdrawal of emergency cover will put our sickest and most vulnerable patients at greater risk. This challenges the ethical framework on which our profession is founded and runs against the grain of our NHS and our personal and professional values”, he adds.

Junior doctors are due to refuse to work in any medical setting at all between 8am and 5pm on 26 and 27 April as part of their campaign of industrial action in the bitter and long-running row with Jeremy Hunt, the health secretary, over the new contract he intends to impose on them from August.

The British Medical Association reacted angrily to Keogh’s intervention. Johann Malawana, the BMA’s junior doctor chair, said: “No junior doctor wants to take this action but we have been left with no choice. They have already done everything else in their power to make their voices heard - protests, marches, petitions, emergency care only strikes. By continuing to ignore them, the government has left them left with no choice.

“We regret any disruption caused to patients and have given trusts enough notice for them to plan ahead, and to ensure that senior hospital doctors, GPs and other NHS staff will continue to provide excellent care for patients. Please be assured that should someone need emergency care on a day of action, they will receive it.

“It is disappointing that Bruce Keogh is attacking frontline doctors rather than echoing calls, from patients’ groups to senior NHS managers, for the government to get back around the table and end this dispute through talks.

In his article, Keogh argues that the continuing series of strikes have caused too much “distress, anxiety and confusion” to patients already through the cancellation of almost 25,000 operations, as a result of four walkouts since January. He says an all-out strike would be “a watershed moment for the NHS”.

Keogh is the first senior doctor to articulate in public the warnings that many leaders of the profession have recently given the BMA privately about the danger of patients dying because too few doctors were on duty. Many of the medical royal colleges, which represent different types of doctors professionally, are torn between support for their striking trainees and fear that doctors’ high standing with the public could be ruined if a total withdrawal of cover is seen as a step too far.

Professor Jane Dacre, the president of the Royal College of Physicians, said: “The escalation of the junior doctors’ action into an all-out strike, to include acute and emergency services, is extremely worrying. At the RCP, we continue to call for compromise, and for there to be constructive renegotiation of the issues that could not be agreed earlier. I urge all my colleagues to think carefully and to do what is in their patients’ best interest, for now and for the future”.

During the four strikes so far junior doctors have continued to work in areas involving emergency care, such as A&E, intensive care, maternity services and emergency surgery. But the BMA’s junior doctors committee decided last month to move to all-out strikes at the end of this month to try to force Hunt to drop his plan to impose the contract, which they claim is unfair on doctors and unsafe for patients.

The doctors’ union claims it has been left with no choice but to strike and hospital consultants – senior doctors – have so far covered junior colleagues’ work during the four walkouts.

In the article Keogh praises junior doctors – all medics below the level of consultant – for the “tough job” they do and expresses sympathy for the fact that they are “tired and demoralised” and feel “disengaged and powerless” for reasons that involve their treatment by the NHS going back years, not just the changes entailed in the unpopular new contract.

But his intervention is likely to lead to many junior doctors denouncing him for betraying the profession. In January it emerged that Hunt’s Department of Health encouraged Keogh, a heart surgeon, to toughen the language of a letter he was writing to the BMA, which raised the possibility that junior doctors may not be available to help hospitals in the event of a Paris-style terrorist attack.

That prompted more than 1,000 doctors to demand Keogh’s resignation as the service’s most senior doctor.