I"m a hospital consultant and I worry about five-day junior doctor strikes

I am worried. Nothing new, you might say, for a consultant working in acute medicine at a busy district general hospital. This time it is not about the acutely unwell patient in front of me but about the announcement by the British Medical Association junior doctor committee (BMA JDC) that junior doctors in England may take part in more industrial strike action. Five days a month of rolling strikes during which there will be withdrawal of all cover from 8am-5pm. These are planned to happen from October onwards unless the government stops the imposition of the junior doctor contract.

As well as being worried I am puzzled. Back in May 2016 the JDC recommended to its members that they accept the new contract, the now leader of the JDC saying at the time it was safe for patients and junior doctors. Despite this the contract was rejected by the membership due to ongoing concerns about weekend pay and people who work part-time. The membership and the rest of us have been waiting to see what would happen next. Junior doctors tell me they do not even know what would need to change within the contract for the BMA JDC to be happy with it. This is surely a damning insight into the BMA’s lack of communication and leadership at such a critical time.

Then the announcement of the longest and most severe set of strikes the NHS has experienced are announced. They appear to be completely out of proportion to the issues that the BMA JDC and its membership still have with the contract. It is not even the whole contract they want rewriting, but elements of it. Despite that, NHS trusts will have to cancel elective procedures, outpatient appointments and draw up emergency rotas if the strikes go ahead. While the BMA has issues with the employer and the employment contract, it will inevitably be the staff and patients caught in the middle of the strikes who will suffer the most.

I am worried about my junior doctor colleagues, many of whom are starting to lose faith in their trade union, the BMA, but fear repercussions if they voice these concerns. They tell me they cannot see how a full strike will help them. They are stressed as they realise the impact of such strike action. They are battling with ethical and moral dilemmas with many not knowing what to do for the best. Some will lose money during the strike making it hard for them and their families financially. Is this really what the BMA JDC intended? There may be a BMA hardship fund for those junior doctors worst affected but there is no hardship fund to support the staff left behind with added stress and work to contend with at an already busy time of year. I feel the BMA JDC have convinced the membership that the issues of NHS under funding, seven-day services etc can be all put together into the justification for the proposed strike.

Many junior doctors tell me they do not want to strike this time – they are in a profession that cares for patients and they fear harm will come to patients during a full and protracted strike. Did any of the voting that junior doctors took part in earlier this year really give the BMA JDC the mandate for these current proposed strikes?

While other NHS staff will provide all the cover and care they can for patients during the strikes, it is clear that patient harm is a real and valid concern. Junior doctors also feel their training could be extended if they miss more than 14 days of work in a year, which is a possibility. What damage is being done to the profession in the public’s eyes? Public support for junior doctors feels as if it is a surrogate for public distrust of the government. The medical profession is one of the most trusted professions but with industrial action planned, the public support will not last forever.

In every strand of this I worry about the patients who will be unduly affected by this strike. They did not ask for this, they have no contract of employment to negotiate; they simply want to be cared for by the NHS.

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I"m a hospital consultant and I worry about five-day junior doctor strikes

Senior colleagues condemn junior doctors" plan for five-day strikes

Senior doctors have voiced strong opposition to the series of five-day strikes planned by their junior colleagues, warning that the action will cause real problems for patients, the service and the profession.

In a surprise statement on Thursday evening, the Academy of Medical Royal Colleges – which brings together doctors’ professional bodies – distanced itself from the doctors’ union, the British Medical Association, which has called the strike. The academy was “disappointed at the prospect of further sustained industrial action by junior doctors”, it said in a statement after several agonised hours of deliberation.

“We are acutely aware that the NHS is under extreme pressure at the moment,” it said. “Patient safety and quality of care must be the priority. We know there are genuine concerns about the contract and working arrangements but we do not consider the proposed strikes are proportionate.

“Five days of strike action, particularly at such short notice, will cause real problems for patients, the service and the profession.”

On Wednesday it was announced that junior doctors will go on strike from 12 to 16 September – the longest period of action yet announced by doctors in their protracted dispute over terms and conditions that the health secretary, Jeremy Hunt, would like to introduce. On Thursday the BMA announced additional dates for proposed walkouts, on 5, 6, 7, 10 and 11 October, 14-18 November and 5-9 December

Junior doctors have long been in dispute with health secretary Jeremy Hunt over conditions of a proposed contract. Photograph: Stefan Wermuth/Reuters

However the BMA is split over whether to support the five-day strikes called by junior doctors, with many of its senior members considering the action unethical and fearful that patients will be harmed.

At a special meeting of the ruling council of the BMA on Wednesday some experts argued that the action was unethical because of the risk to patient safety, the Guardian has learned.

Such was the importance of the meeting that some council members changed their holiday plans to be there. Following a highly charged discussion, the BMA council voted by 16 to 12 to support the junior doctors’ industrial action.

The opposition of senior doctors raises questions over whether the industrial action can go ahead as planned. The opposition of the royal colleges may persuade some junior doctors not to take part and they may also lose the support of some senior doctors who were expected to cover for them during the strikes.

The Patients Association’s chief executive, Katherine Murphy, said the organisation was “gravely troubled” at the “catastrophic impact this will have on so many patients and their families” as winter approaches. “Many patients may be very unwell or vulnerable and so we cannot predict the distress or pain this will cause to everyone this will affect,” added Murphy.

Katherine Murphy, chief executive of the Patients Association, said the organisation was concerned about the impact of the strikes, especially during winter. Photograph: Martin Argles for the Guardian

Earlier in the day Hunt said in a series of broadcast interviews that junior doctors would be inflicting “the worst doctors’ strike in NHS history”. The minister told Sky News: “Patients will be asking why it is that the BMA, who only in May said ‘this deal is a good deal for doctors, a good deal for patients, it’s good for the NHS, it’s good for equality’ are now saying it is such a bad deal that they want to inflict the worst doctors’ strike in NHS history.”

Theresa May, accused the BMA of playing politics, reiterating her confidence in Hunt during a visit to the Jaguar Land Rover assembly plant in Solihull.

“Jeremy has been an excellent health secretary, he is an excellent health secretary and this deal is about a deal that is safe for patients and I think it’s crucial if you look at what we’re doing as a government with the NHS,” the prime minister said. “We’ve got record levels of funding into the NHS, we’ve got more doctors now in the NHS than we’ve seen in its history and this is a deal that is safe for patients.

“The government is putting patients first, the BMA should be putting patients first – not playing politics.”

Most senior doctors condemn Hunt for his continuing threat to impose a contract on them that they say does not recompense them for Saturday shifts and will jeopardise patient safety, because of the excessive hours they will be asked to work.

Earlier in the day, the president of the Royal College of Physicians of Edinburgh, which has members across the UK, called on the government to negotiate but made it plain he opposed the strikes. “The safety of our patients and the wider NHS workforce remains paramount and this long-running dispute benefits no one,” said Prof Derek Bell.

“We are concerned that the industrial action proposed will have a significant impact for patients and all healthcare professionals in the NHS. The timing of the proposed industrial action – so soon after the August changeover with many junior doctors new in post and heading towards the winter months – and the sustained nature of the action will heap pressure on a health system that is already struggling to deal with existing pressures and rota gaps. The proposed notice will also make it extremely difficult for hospitals to arrange cover. We hope that this action can be avoided.”

Dr Mark Porter, chair of the BMA council, said the decision to announce five consecutive days of strike from 12 September was taken after “long and difficult debates”. He said Hunt had left junior doctors with no alternative but to strike again. “The reason the strikes have been announced is the continued reluctance of the secretary of state for health to do anything other than impose a new contract on junior doctors, a contract in which junior doctors have demonstrated repeatedly that they do not have confidence.”

Opinion among doctors who responded to a Guardian call for comment was very divided, with some saying the strike action does not go far enough but others against it, even though they support the junior doctors’ cause. “It is the Department of Health, not us, [which is] endangering patient care by trying to impose an unsafe contract that is also unfair. I’m hopeful that the public understands this – I became a doctor to care for people and it is in the interests of protecting my ability to do so that I’m going to be going back out on strike,” said a 32-year-old anaesthetist.

But a 28-year-old junior emergency medicine doctor said: “Appalling. I’m shocked that the new leadership of the BMA is taking such a damaging step. I can see why they may want to strike – and I’d be OK with a one day walk out – but this is insane.”

There is likely to be close scrutiny of the turnout for the first strike, which begins on 12 September. The last walkout, which was the first full withdrawal of labour, saw 78% of junior doctors fail to report for duty on 27 April, although this would have included some absent for other reasons such as illness.

That was down on the previous strike for the period of 6 to 8 April when emergency care was provided while 88% were on strike, according to NHS England.

There was also a drop in public backing for the action as a result of the full withdrawal of labour, according to an Ipsos Mori survey for BBC News. It found 57% of adults supported the strike at the end of April compared with 65% the previous month. The proportion who blamed both sides for the dispute was also up.

The action on 26 and 27 April saw around 13,000 operations and 113,000 outpatient appointments cancelled. Extrapolating those figures over five days and then multiplying by four to account for the strikes planned each month until the end of the year, the Department of Health is predicting that up to 125,000 operations and over 1 million outpatient appointments could be cancelled as a consequence of the latest wave of walkouts.

• This article was amended on 2 September 2016. Professor Derek Bell is president of the Royal College of Physicians of Edinburgh, not the Royal College of Surgeons of Edinburgh as a previous version stated.

Senior colleagues condemn junior doctors" plan for five-day strikes

Junior doctors to stage five consecutive days of strikes in September

The British Medical Association has announced a new wave of strikes by junior doctors in England this month – the first since its members rejected the government’s final offer on their new contract.

Junior doctors are to stage five days of strikes with “full withdrawal of labour” between 12 and 16 September, the British Medical Association has announced.

There will be a full withdrawal of labour, including junior doctors working in emergency departments, between 8am and 5pm on the days in question.

The industrial action will further test the NHS, already said by trusts to be at breaking point due to increasing demand for services, staff shortages, and insufficient funding.

There have been five previous walkouts in the dispute, all this year. The longest lasted for two consecutive days, and the first all-out strike – including junior doctors working in emergency departments – was held in April. More than 100,000 operations and outpatient appointments have been cancelled as a result of industrial action to date.

In May a compromise deal was agreed between the BMA and Jeremy Hunt, the health secretary, but last month members of the doctors’ union voted against accepting it by a margin of 58% to 42%. As a result, Hunt is pushing forward with plans to impose the contract on junior doctors – those below the level of consultant – in October.

About 37,000 BMA members, or 68% of the 54,000 trainee doctors and final- and penultimate-year medical students who were eligible to vote, took part in the ballot on the settlement.

Dr Johann Malawana, then chair of the BMA’s junior doctors committee, had recommended the revised terms and conditions as the best deal junior doctors could get, but resigned after the ballot results were announced, and was replaced by Ellen McCourt.

The Department of Health accused the BMA of putting confrontation before cooperation in order to score political points. A spokesman said: “As doctors’ representatives, the BMA should be putting patients first not playing politics in a way that will be immensely damaging for vulnerable patients. What’s more, the BMA must be the first union in history to call for strike action against a deal they themselves negotiated and said was a good one.

“Whilst there are many pressures on the frontline, funding is at record levels, with the highest number of doctors employed in the history of the NHS. Co-operation not confrontation is the way forward to make sure patients get the best treatment and the NHS is there for people whenever they need it.”

Junior doctors to stage five consecutive days of strikes in September

Junior doctors "push for monthly five-day strikes"

Junior doctors are pushing for monthly five-day strikes to be held between now and the end of the year in an escalation of the dispute over their new contract, according to leaked documents.

Senior members of the British Medical Association (BMA) are meeting on Wednesday to decide what industrial action – if any – should take place after a compromise deal on the contract agreed with the government was rejected by its members last month.

The Mail reported that it had seen a 13-page document marked “confidential” which states that the BMA’s junior doctors committee (JDC) is proposing a full withdrawal of labour between 8am and 5pm for five consecutive weekdays in September and then further walkouts of the same duration in each of the remaining months of the year.

The BMA refused to comment on the specifics of the industrial action being considered but a source said “anything is up for discussion”.

Last month, the JDC chair, Ellen McCourt, wrote to members informing them that the committee was planning “a rolling programme of escalated industrial action beginning in early September”.

The decision will ultimately taken by the BMA council, effectively the union’s board of directors, which usually has 34 voting members.

There have been five walkouts by junior doctors to date, the longest lasting for two consecutive days. The first all-out strike, including junior doctors working in emergency departments, took place in April. More than 100,000 operations and outpatient appointments have been cancelled in total as a result of all industrial action to date.

A breakthrough in the dispute appeared to have occurred in May, when the JDC and health secretary, Jeremy Hunt, agreed a revised contract. However, almost six in 10 junior doctors – all doctors below consultant level – and medical students (58%) who belong to the British Medical Association refused to accept the compromise deal, with only 42% endorsing it.

About 37,000 BMA members, or 68% of the 54,000 trainee doctors and final and penultimate-year medical students who were eligible to vote, took part in the ballot.

After the vote, the JDC chair, Dr Johann Malawana, who had recommended the revised terms and conditions as the best settlement junior doctors could get, resigned from his position. He was replaced by McCourt.

A BMA spokeswoman said: “Junior doctors have been clear in their rejection of Jeremy Hunt’s imposed contract. It should come as no surprise that BMA council are discussing the issue of further industrial action. But at this stage, no decisions have been made.”

Junior doctors "push for monthly five-day strikes"

Junior doctors consider further strikes in contract dispute

Junior doctors are considering further strikes in September after rejecting the health secretary Jeremy Hunt’s proposed new contract.

Ellen McCourt, who chairs the British Medical Association’s (BMA) junior doctors committee, said that by standing together they could demand the government takes them seriously.

Strikes took place between January and April after junior doctors failed to come to an agreement with the government. In July the government announced it would impose a contract after junior doctors and medical students voted to reject a deal brokered with the BMA.

In a letter to members released on Thursday night, McCourt said the government had remained “persistently silent” on the issues she said had led to the rejection of the contract.

— #hellomynameisEllen (@McCourtEllen) August 11, 2016

The road ahead will not be easy,by standing together we speak with one voice,our unity remains our strength @TheBMA pic.twitter.com/DAuXhf5fjS

She said: “In light of this, the JDC executive has voted to reject the proposed new contract in full and to call for formal renegotiations on all of your concerns.

“In response to the government’s silence, JDC exec has today made a formal request for a special meeting of BMA council to authorise a rolling programme of escalated industrial action beginning in early September.”

She said the BMA could not stand idly by as the date for imposition drew nearer, and argued that forcing a contract on doctors that they did not have confidence in would be bad for patients.

Daniel Mortimer, the chief executive of NHS Employers, said: “Industrial action achieves little or nothing but places pressure on already stretched teams and services and causes worry, distress and disruption for patients, carers and their families.

“Over the last two months we have been talking with the junior doctors committee and have, along with the Department of Health and others, responded positively to their concerns regarding the guardian role and whistleblowing.”

He said employers were serious about “positive engagement” with the BMA.

Junior doctors consider further strikes in contract dispute