“Safe”; “fair”; “a really good package of things for equalities”. This was how Ellen McCourt, the new chair of the British Medical Association’s junior doctor committee, described the renegotiated contract the BMA agreed with the Department for Health earlier this year. Yet just weeks later, the BMA has announced an unprecedented level of strike action over that same contract: four five-day strikes, including the removal of emergency care. How have we got here?

After more than three years of contract negotiations, it’s easy to lose sight of why the junior doctor contract was being renegotiated in the first place. All sides agreed the old contract – which resulted in unpredictable pay packets, and equal rewards for doctors working very different levels of unsocial hours – was unfit for purpose.

Despite protracted negotiations neither side has been able to reach agreement. Before the summer, the BMA and the government finally agreed a new compromise contract after eight days of intensive Acas negotiations. Yet despite the BMA endorsement, junior doctors rejected this contract by 58% to 42% in a vote.

This left the BMA in somewhat of a quandary. But having recommended the contract to its members as fair and safe, it is impossible to make sense of its decision to aggressively escalate strike action in the wake of the vote.

For medical professionals, the decision whether to strike must be one of the utmost gravity. Every day of strikes means thousands of operations cancelled, causing huge patient suffering. Withdrawing emergency care at short notice for sustained five-day periods creates serious risks to patient safety.

In the past, the BMA has justified strike action by arguing that the government’s proposals – even after significant modifications made in February – represented an even bigger risk to patient safety, although it failed to set out a convincing public explanation of why and how that was the case. But to escalate strikes on the basis of a contract the BMA itself has declared safe seems bizarre at best. At worst, it leaves the BMA vulnerable to the charge these strikes are politically motivated.

As this paper has argued, the government has been far from blameless in this dispute. Jeremy Hunt originally approached the negotiations in an unnecessarily combative style. His decision to rhetorically link contractual reform to an unfunded Conservative manifesto commitment for seven-day NHS services was a mistake, and had an incendiary effect. But the government has shifted its approach in recent months, making significant concessions.

Yet as the government’s approach has become more conciliatory, the BMA has upped the ante. The public has the right to expect industrial action should be deployed as an absolute last resort given doctors’ ethical responsibilities. But the Health Services Journal has published leaks of private messages between the BMA’s junior doctor committee that suggest that – far from being deployed as a last resort – strikes were seen as a tool to prolong the dispute, causing maximum difficulty for the government. One committee member said weekend pay was “the only real red line” for doctors, directly contradicting the BMA’s public stance that this was a dispute about patient safety.

It remains unclear what this strike is actually about. In the media, the BMA and many grassroots doctors continue to argue it is about the government putting patient safety in danger by pledging to deliver seven-day services across the NHS without increasing the number of staff. But the contract itself neither requires doctors to work more weekends, nor reduces staffing during Monday to Friday. It emerged yesterday that in May the Department for Health was willing to issue a statement to junior doctors that made clear seven-day services would be limited to emergency care, with extra staff deployed. The BMA at first signed off this statement as part of the Acas process, then insisted the department refrained from releasing it as they regarded it as irrelevant to the contract.

This clarification could potentially have won more junior doctors round to voting for the compromise contract. Why did the BMA not want this statement publicised, and why are its leaders continuing to argue this contractual dispute is about the government’s commitment to seven-day services? In the absence of a good explanation, it is hard to avoid concluding this dispute has morphed from an industrial one about contractual reform into a political attack on the government, with insufficient regard for the cost in patient suffering.

There is also evidence the BMA might be out of step with its members. Just 32% of the 7,000 doctors that took part in a leaked BMA survey back in May said they supported time-limited strike action, and 36% unlimited action. Despite its serious escalation, the BMA has not balloted its members on strike action since last November.

Of course junior doctors work long hours in difficult conditions. Many have legitimate grievances, including serious concerns about the current NHS funding crisis. But these grievances are not contractual. Using escalated strike action on the basis of a contractual dispute to air these grievances may be tempting, but it is ultimately counterproductive.

This paper is a staunch defender of the critical right to take industrial action. But with that right comes responsibilities. The BMA’s leadership, looking increasingly driven by political rather than industrial concerns, has failed in those responsibilities: to its members, to the NHS, and ultimately, to the public.