A tale of three disputes: Junior doctors against the government 2015-2016

The junior doctors’ strike may be over, but the issues it revealed will not go away

In November 2015 junior doctors in the National Health Service in England voted to take strike action if the government did not change its mind about a new contract, which had been debated for the previous two years. Just over 37,000 junior doctor members of the British Medical Association were balloted, 76 per cent responded and 98 per cent of responders voted to strike - an expression of militancy on an unprecedented scale in the UK’s public sector. But in September 2016 the strike collapsed. This review attempts to explain the course of the dispute, and the causes for its defeat.

The first 24-hour period of industrial action took place on 12 January, with junior doctors providing emergency care only. Pickets outside hospitals carried banners about saving the NHS, and making the NHS safe for patients, and being treated without respect by the government. The Secretary of State for Health, Jeremy Hunt, became a hate figure for the medical profession, and public opinion sided with the junior doctors. And in further one- and two-day strikes in February and March junior doctors continued to maintain emergency care. But this was withdrawn in the two-day stoppage of 26 and 27 April. This prompted more talks, and on 18 May ACAS announced that agreement on a new contract had been reached.

The BMA leadership recommended the new contract to its junior doctor members, but in July 58 per cent of them rejected it, in a 68 per cent turnout. The government announced it would still go ahead with phased introduction of the new contract, beginning in August, and in response the BMA junior doctors’ committee prepared for more strike action. Dr Yannis Gourtsoyannis, a member of the committee, outlined plans for repeated and crippling strikes, and increasing pressure on NHS services as winter approached in ‘an escalated fight’ to get ‘more and more’ out of the government, and to wage war on its policies (Daily Telegraph 12.8.16). But a proposed five-day period of industrial action was called off after many members contacted the BMA arguing that the planned action was disproportionate; and then on 24 September, following negative feedback from doctors, patients and the public, the BMA announced a suspension of any further industrial action in England.

What triggered this dispute and why did it lose its momentum? My argument is that a key problem was that it consisted of three conflicts rolled into one, making it difficult to settle but also impossible to sustain. The conflicts were over the details of overtime pay in a new contract specific to doctors in training; the strains currently being experienced by the NHS due to government limits on its funding and the pressure for a ‘seven-day NHS’; and changing patterns of medical work for doctors in training. The first three parts of this review discuss these three aspects of the dispute, while a final section looks at the strategy and tactics of the junior doctors’ campaign.

The contract

Junior doctors are doctors in training posts, on their way to becoming consultants or general practitioners. They remain ‘junior’ for between four and ten years, depending on the specialism and their own circumstances. They are allocated to the training posts by ‘Deaneries’, bodies responsible for overseeing training in the NHS. This allocation of posts can separate couples, and is unpopular with doctors (because it limits their choice of workplaces) whilst being popular with the NHS (because it fills posts). Their basic annual salaries are in the range £23,000 to £40,000, before overtime and depending on experience.

Junior doctors have always worked long hours. In the 1970s an 80-hour week was common, and overtime (after 44 hours) was paid at one of third normal time. Not surprisingly, such exploitation was challenged in a three-month industrial dispute in the winter of 1975/6. The result was a commitment by the NHS to reduce hours, and a somewhat improved pay deal...