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Editor's Choice

Breaking point

BMJ 2016; 353 doi: (Published 21 April 2016) Cite this as: BMJ 2016;353:i2260
  1. Fiona Godlee, editor in chief
  1. The BMJ
  1. fgodlee{at}

The long running and damaging dispute over the junior doctors’ contract enters a new phase this week. At its heart is whether weekday pay rates should apply on Saturdays, a move the government claims is essential to establish a “seven day NHS.” The junior doctors assert that existing resources will be spread too thin, creating gaps in rotas, making it hard to recruit and retain good doctors, and putting the long term staffing and safety of the NHS at risk ( With no sign, at the time of writing, of either side stepping back from the brink (doi:10.1136/bmj.i2238), England’s junior doctors will next week take part in the first ever all-out strike by doctors in the UK.

On the face of it the government has the least to lose. Despite apparently retreating from “imposing” the contract in preference to “introducing” it (doi:10.1136/bmj.i2237), the health secretary seems confident that he has the necessary powers to implement his plan. But in failing to resolve the dispute Jeremy Hunt puts at grave risk his ability to manage the wider crisis facing the NHS (doi:10.1136/bmj.i1022). And Hunt’s rock bottom relations with the health professions make holding onto his job beyond the EU referendum unlikely.

For doctors the stakes are higher. Public support for the juniors remains strong (, but next week’s strike could prove a tipping point, especially if a patient were to die or be seriously harmed as a result of the withdrawal of emergency cover. Also potentially at risk is the BMA’s role of national negotiator, as trusts consider making local arrangements. Foundation trusts have the legal right to negotiate local terms and conditions and may be tempted to do this to attract juniors (doi:10.1136/bmj.i2255). The alternative is to continue their disastrous spending on locum staff.

The juniors may have looked like easy pickings. So far the government has failed to isolate them from their senior colleagues, but this solidarity is not impervious to government blandishments. Prominent seniors are now calling for the juniors to concede (;;, and the proposed new contract for the seniors notably retains premium pay on Saturdays (

This is an unnecessary dispute with many underlying agendas and few possible outcomes, none of them good. Juniors’ hours were never cited by NHS England as a barrier to a seven day service ( The priority was always more consultant cover to speed up decision making and provide greater support for juniors.

Ostensibly the government’s goal is a seven day service. In reality it looks like being about breaking the doctors’ union. Who can tell what the effect will be on the NHS and patients if the government succeeds?


  • Editorial note: The BMJ is published by BMJ (BMJ Publishing Group Ltd), a wholly owned subsidiary of the British Medical Association. The BMA grants editorial freedom to the editor of The BMJ (currently Fiona Godlee). The views expressed in the journal are those of the authors and may not necessarily comply with BMA policy. The BMJ follows guidelines on editorial independence produced by the World Association of Medical Editors and the code on good publication practice produced by the Committee on Publication Ethics, and the EQUATOR network resource centre for good research reporting.

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