Unprecedented UK junior doctors’ strike action
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* Owen Dyer

After a weekend of last-ditch efforts failed, England is in the midst of its first comprehensive junior doctors’ strike in the 68-year history of the National Health Service (NHS).

The two-day strike, on Apr. 26 and 27, is the [fifth time England’s junior doctors](http://www.cmaj.ca/lookup/doi/10.1503/cmaj.109-5219) have taken industrial action over a new contract with the government, but this walkout exceeds all the others in scope. Even doctors working in maternity, intensive care, and accident and emergency have been urged to stop working by the British Medical Association (BMA) and its junior doctors’ committee.

The NHS says 112 856 outpatient appointments and 12 711 planned operations will be postponed due to the strike. The action does not extend to Scotland, Wales or Northern Ireland, whose devolved governments have not drawn up new contracts.

The origins of the dispute lie in the government’s decision to build a “seven-day NHS,” based on research suggesting that mortality is higher among NHS patients admitted on weekends. The new contract sharply cuts the number of hours for which premium pay rates apply. The hours currently considered normal time are 7 am–7 pm, Monday to Friday. Under the new contract, normal pay would apply from 7 am–10 pm, Monday to Saturday.

Other provisions in the 80-page contract reduce overtime pay opportunities for doctors who work fewer total hours, and link pay increases to grade rather than years worked. The junior doctors argue these measures discriminate against women. The BMA has launched a judicial review of the contract, accusing Health Secretary Jeremy Hunt of breaching the law by failing to carry out an Equality Impact Assessment.

Several senior doctors’ groups reassured the public that their members would fill any gaps in care during the two-day walkout.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/188/9/E169/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/188/9/E169/F1)

The British Medical Association urged junior doctors to strike.

Image courtesy of Barbara Sibbald

A letter to Prime Minister David Cameron and Hunt on Apr. 23, signed by more than 2500 senior doctors, expressed support for the strikers, but added: “We, the senior specialists, will keep the NHS safe for our patients and your constituents, despite much publicity to the contrary.”

On Apr. 24, Hunt rejected a letter spearheaded by Shadow Health Secretary Heidi Alexander and signed by two former health minsters, calling for the contract to be piloted on a limited basis. Hunt described the offer as [“political opportunism”](https://twitter.com/Jeremy_Hunt/status/724166951178784769) in a tweet, and sent a counter-proposal to the BMA, which was also rejected.

On Apr. 25, the leaders of 14 of Britain’s medical royal colleges wrote to Cameron that the ongoing impasse “poses a significant threat to our whole health care system by demoralising a group of staff on whom the future of the NHS depends.”

Informal surveys have shown [more than half of junior doctors are thinking of quitting](http://www.theguardian.com/society/2016/apr/25/junior-doctors-over-half-could-quit-nhs-england-over-hunt-contract) NHS England. Dr. Francesca Silman is one of five junior doctors seeking a second judicial review of the proposed contract that challenges Hunt’s right to impose it. He said all English doctors know colleagues who have gone to Australia, and hear the “siren call” of shorter hours, better pay and less stress, He said that those who had left “miss the comradery and sense of purpose of the NHS.”

The government claimed that the dispute was over pay, “but for me the biggest issue is working hours per week,” said Silman. An objective limit is to be replaced by a “completely subjective system where you have to complain if you’re overworked. We’re heading straight back to 100-hour weeks.”

Ben White, a junior doctor, made newspaper headlines on Apr. 25 when he resigned during an interview on the morning television news show *Good Morning Britain* to focus on the judicial review campaign. White told *CMAJ*: “I feel it’s my duty to act in this way. We’re doing this for the long-term benefit of our patients. If we say we cannot be spread any thinner, I think it can be justified to them.”