The BMA have raised the stakes with their newest strike proposals

Edmund Stubbs, 24 March 2016

The British Medical Association have taken an extremely bold move in deciding to hold two full walk outs for the first time over new junior doctor contracts; these are in addition to an already planned 48 hour strike on the 6th of April. The two more severe strikes are scheduled for the 26th and 27th of April.

So why will these new strikes be different? Although the previous three strikes saw the majority of junior doctors in England not turn up for work, choosing to man picket lines instead, those of them with responsibilities in emergency care such as in A&E, emergency surgery and some parts of intensive care reported for duty as usual.

Consequently, although many elective procedures were cancelled, the nation’s emergency services continued to function normally. Although postponing any scheduled medical procedure implies some level of risk, the main effect of the recent strikes was to inconvenience rather than endanger patients.

Junior doctors enjoyed considerable levels of public support during each of their previous strikes. However, according to an Ipsos MORI poll commissioned by Newsnight and the Health Service Journal, public support for the coming ‘total’ strike has fallen from 66 to 44 per cent. The number of those opposed to the total strike has also risen dramatically; from 16 to 39 per cent, largely due to the threat of emergency care no longer being provided.

With consultants providing the emergency care normally undertaken by their junior colleagues, there is a possibility that the safety of patients might actually improve during these total strikes. Instead of patients arriving at A&E being treated by a collection of junior doctors led by one consultant, they will be in the care of an entire team of consultants. During the strike patients on normal hospitals wards may run some extra risk if their condition were to deteriorate without the normal close supervision of junior doctor and consultants, but, by and large, patient safety should still be ensured.

In a way, however, this is of little importance. What is essential to the junior doctors’ cause is public opinion, that is, each individuals’ interpretation of the dangers threatened by the strike, and who they will deem to be responsible for those dangers. Such severe strike action does certainly seem to represent a desperate recourse from the BMA. Most people are likely to automatically view a walk out of emergency junior doctors as being dangerous, and will certainly worry about what might happen to them were they to fall ill on a total strike day and whether or not their local A&E department might resemble a scene from the apocalypse.

The BMA are taking a dangerous gamble. If they have judged their move rightly they could provoke the public to take up arms against the Health Secretary, furious at how he could treat NHS doctors so badly as to make them abandon their most basic, even moral, responsibilities. If the BMA have judged it wrongly however, it could lead to the public blaming junior doctors for being reckless with regard to patient safety and being unwilling to compromise. The January poll suggests that the public does indeed consider a junior doctor presence in A&E and similar services as an essential duty.

With the government’s new consultant contract negotiations allegedly going well, and a draft for consultants to review to be made available within a few weeks, it could be that the BMA’s junior doctors have acted out of desperation. After all, if the contract for their seniors is accepted they will be left isolated from the rest of their profession. Each strike has attracted noticeably less media attention than the previous one, although the disruption for patients and the service arising from each is the same.

The abandonment of emergency services in the forthcoming strikes by junior doctors could represent a last ditch attempt to keep their contractual dispute in the media spotlight during the next two sets of strikes, and to harness British public opinion into forcing the government to abandon its imposition of the new contract upon them before it is too late and their campaign loses momentum.

Edmund Stubbs is Healthcare Researcher at Civitas