Junior doctors are not backing down to Jeremy Hunt – this fight is still about more than money

The BMA has asked for agreement on three principles: the junior doctor contract must not be discriminatory, it must not hamper recruitment to medicine and it should not leave the NHS under-resourced

Junior doctors striking outside North Middlesex Hospital last week (Rex)

What a weekend it has been. The sun is shining, we have a Muslim Mayor in London, and the junior doctor contract negotiations are back on after the Academy of Royal Colleges intervened, asking for a “a five day pause without ‘ifs, buts, and maybes’”.

Let’s be clear about one thing: doctors have not backed down from their position. In fact, both the government and the BMA have returned to the negotiating table without any preconditions – and the collective sigh of relief was palpable. Finally, a conclusion to this long-running dispute is within reach.

However, confirmation that talks would restart was soon followed by a rebuttal by Health Secretary Jeremy Hunt, who asked for written reassurance from the BMA asking that the “90 per cent of the issues (already) agreed” must not be revisited – including the misguided principle of delivering a seven-day service while maintaining strict “cost neutrality”. Hunt stipulates that the only area that the BMA should be willing to negotiate over is the “single biggest area of disagreement”, that of Saturday pay.

The BMA junior doctor committee agrees – as it always has – that talking is the only way to break this impasse. Industrial action had always been a last resort when pushed into a corner.

But the BMA has specifically asked for agreement based upon three principles: the junior doctor contract must not be discriminatory; it must not hamper recruitment and retention in specialties already in crisis; and it must deliver an evidence-based, fully resourced, world class healthcare service. Nothing about Saturday pay there, because, as junior doctors have always said, to turn this into a dispute about pay would ignore the greater issues of patient safety and ensuring a sustainable workforce for a future NHS.

There is still work to do on our three key demands. The Equality Impact Assessment conducted by the government about the junior contract admits discrimination against part time working, women and lone parents, but justifies it but stating it is "proportionate" as it achieves a "legitimate aim". This retrograde step attacks everything that has been achieved in medicine over the past 60 years: 55 per cent of medical students are women, currently 44 per cent of registered doctors are women (up from 10 per cent in the 1960s) and 54 per cent of junior doctors are female, yet women are under-represented in medical leadership and academic roles with only 32 per cent of consultants being female and only 24 per cent of medical directors are women. There is increasing discomfort within all political parties that this contract pours concrete on the glass ceiling already in place.

Meanwhile, data from Health Education England confirms that hundreds fewer junior doctors have applied to continue their NHS training in the key specialties of paediatrics, obstetrics and gynaecology, and emergency medicine. Medical school applications have fallen by 13.5 per cent in two years ago with negative publicity about the NHS suggested as part of the reason (as well as the rising cost of university education, with the debt accrued over the course of a medical degree estimated at £70,000).

Rota gaps are common place, with doctors often being asked to work extra shifts. The new junior contract will worsen these gaps by stretching the already thin workforce across the weekend to provide cover for the as yet undefined seven day NHS. As doctors on the frontline, we know all too well that trying to force seven day service out of existing staffing will only need to more exhausted, demoralised doctors and unsafe practice.

Put simply, there has been a conflation of issues. To date, there is no evidence that changing junior doctor contracts will lead to a seven day NHS. The imposed junior contract will take the same number of junior doctors and spread them more thinly over seven days resulting in less coverage overall. This means that, despite increasing coverage over the weekend, there would be fewer doctors during the week to provide both a routine and emergency service. Senior politicians, commentators and academics all agree that the imposition of the junior contract is not the answer to address any weekend effect. The weekend effect is not about pay – it’s about safety.

Now we have the chance for a solution. Hope is spreading among the 54,000 junior doctors. The question of who blinks first is moot; everyone needs a resolution to this situation – the doctors, the government and, lest we forget, the patients who have unwittingly become a casualty in this dispute with countless appointments and procedures being postponed.