Junior doctors: after the strike who will be the peacemakers?

Winter is coming and with it the very real prospect of strike action by thousands of junior doctors across England.

A walkout, probably in early December, will cause substantial disruption and is triggering real concern among service leaders particularly due to uncertainty over what form the action will take.

Many are now questioning whether the battle is worth the metaphorical bloodshed.

Junior doctors are enraged and the contract dispute has served as a lightning rod for many perceived wrongs over recent years. Nothing will bring them back from the brink and a cathartic day of protest action seems inevitable, and is perhaps necessary at this stage.

Members of the consultant body will back trainees but they should not write a blank cheque to their younger colleagues, especially when progress on their own negotiations is at a fragile state.

The British Medical Association appears to want to forget that it was its own ill judged decision to walk out of negotiations without warning in October 2014 that forced the government to pursue a proposal without talks.

It now demands the government withdraw the threat of imposition, but no government could ever agree to such terms - it is akin to asking a union to enter talks with a promise it will never take strike action.

The government, for its part, continues to conflate sensible reform of junior doctor contracts with the issue of seven day working with predictably inflammatory results. Its latest offer to doctors is mired in complexity and there is no clear detail on who actually gains and loses compared to the current contract.

Pay protection is an interesting concession but it also masks the long term effect of the contract on future junior doctors, who are as equally important in the discussion as those training now.

The consensus among senior clinical and non-clinical leaders at HSJ’s annual summit this week was that the dispute has been badly handled by both sides.

Minds at the Department of Health and the BMA need to turn to what happens next after industrial action – a prolonged dispute is in nobody’s interest, least of all NHS patients.

When the dust settles after the first day of action, the time will be right for third party intervention and possibly mediation.

The BMA will struggle to corral its membership down that road given the strength of feeling, while the government will be reluctant to give ground after a three year delay it largely blames on the BMA. Both sides will need to be pragmatic.

Mr Hunt has become personally associated with the dispute and the anger felt by doctors. Both supporters and critics are counselling him to take a step back and allow another government minister to take point on the issue.

Who will be the peacemakers? The medical royal colleges must surely have a role to play in suggesting a sensible way forward that should be respected by doctors, politicians and the public.