This is not a veto; why the doctors' contract opposition is crucial to the NHS

The junior doctors' opposition to a new '24/7' contract is a subject of controversy, framed by the mainstream media as a bitter stand-off between the Conservative government and the British Medical Association (BMA). This 'war of attrition' holds the much more important fate of the NHS in its hands. The most recent manoeuvre by the Health Secretary, Jeremy Hunt, has been to accuse the BMA of attempting to 'veto' the Conservatives' manifesto pledge for a seven-day elective NHS, in a revolutionary attempt to overturn the government. As well as sensationalist absurdity, it could not be further from the truth.

The manifesto promise has never been a viable option. Due to budget cuts, soaring service demand and dwindling numbers of healthcare staff, the NHS can barely support five-day elective care. This is only set to get worse. The imposition of a 'cost-neutral' contract, promising to extend services into seven days without tackling the above problems, is doomed to fail and take the NHS with it. It is not a question of doctor agreement or political strength, but a question of supply and demand.

The doctors' opposition, a legal, safe and publicly supported action, is a desperate attempt to block the above contract and its potential to overstretch NHS resources to the point of failure* (not to mention driving women out of the profession through open discrimination against them in its clauses).

Throughout, Whitehall's political rhetoric has been that the doctors are striking over Saturday pay. Whilst a near one third pay cut is unfair, this tactic undermines public trust in its most celebrated service as well as distracting from the real issues. Worse still is a cynical attempt to drive conflict between public services and break public support. An enemy divided is an enemy conquered. It is hard to believe that in the 21st century a government would vilify its own public services to fulfil a dangerous manifesto promise, to no benefit and in the clear ignorance of expert opinion, even from within its own ranks.

Doctors do not wish to veto a seven-day NHS and see hypothetical benefits in elective seven-day care, if it could be safely implemented. This has never been a political fight on the side of the BMA or doctors; they have just come up against a political machine that cannot afford to back down against a powerful union. Doctors wish only to bring the government to terms with the reality of its safe implementation.

The issue is that unless the government can knowingly estimate and provide the adequate resources (money, doctors and other healthcare staff), its 'reforms' will cost lives.

We are already spinning several plates in the air, and by extending the workforce into the weekends without extra support, the plates will begin to fall. Plates, like lives, shatter.

As doctors we are trained to recognise illness, stratify risk and treat. We are also taught to be highly self-critical and reflect on our motives. Here we see a sick service requiring treatment, more resources, more funds and, most importantly, a brain that needs to reconnect with the working body. The solution to this problem is the government admitting that the BMA is not politicised or militant but simply doing its job by protecting patients and the NHS. Both sides need to negotiate without precondition or imposition -such stubbornness is intolerable when lives are at risk. Now is a time for reasoned adult discussion, not posturing and name calling.

The potential for change lies with you. The government must realise that the fate of the NHS may hinge on this contract. So please, write to your MP and ask questions of your government and your doctors. Let the government know that a safe NHS is worth more than an empty and dangerous manifesto promise. The NHS has looked after Britain for 70 years and now we need your help to look after it. A political party can be forgiven for making a mistake, but first it must be ready to change. If we fail, consider this new contract will be its epitaph.


The authors are junior doctors, based in the Southwest. The views expressed are those of the authors and not their employer.

Read more articles by Dr Ben Janaway


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