What Happens Next in the Junior Doctors Dispute?

Today and tomorrow, junior doctors in the NHS will stage their first ever all-out strike. It's the third strike by junior doctors since the beginning of the year, but during this walkout they will not be providing on-call emergency care. They've been driven to this by the Conservative health secretary Jeremy Hunt, who wants to impose a new contract that would make them work more hours, stretching them beyond their capacity and, they say, endangering patients.

The strike is likely to go off as the other two did. It will cause disruption – thousands of outpatient clinics will be affected and planned surgeries will be postponed – but the walkout is unlikely to pose any serious danger to patients. Tens of thousands of consultants and other clinical staff are being brought in to cover emergency care and the day-to-day running of the hospitals. We're unlikely to see the Sun's warnings of emergency field hospitals being set up in tents coming true.

With the dispute continuing to escalate, what happens next? Is it possible that the sensationalist warnings could become less ridiculous? Will the fight only end when NHS hospitals begin to look like something from a Vietnam war epic IRL and not just on the front pages of the tabloids?

Beyond this week's strike, neither side looks set to budge. The health secretary is giving no signs of conceding anything to the doctors and has stepped away from the negotiating table.

"Everybody credible has told Jeremy Hunt to keep talking to the junior doctors… 22 different medical royal colleges have tried," says Dr Phil Hammond, Private Eye's health correspondent of nearly 25 years. "I suspect that if we kidnapped Jeremy Hunt's kids he'd not return to negotiations. I don't know what's gone on with him. He's got tunnel vision."

On the other side, the junior doctors appear steadfast in their resolve to not accept the contract as it stands. Emails sent by the chair of the British Medical Association's (BMA) junior doctors committee, Dr Johann Malawana, seen by the Health Service Journal, said if this week's strike had no effect, an indefinite strike from the 8th of June was one option in their ongoing campaign.

However, the junior doctors – like the royal colleges – have been continuing in their attempts to get Hunt back to the negotiating table. "Even up to the last minute, this weekend, we've literally been standing outside the Department of Health trying to speak to Jeremy Hunt to avoid this strike," says Dr Jeeves Wijesuriya, a junior doctor and member of the BMA's negotiating team. "He says the door is open and that he wants junior doctors to come back to talk to him, while in reality he's been sneaking out the back door of the department to avoid us. We've been to his place of work, his home constituency, but he's dodged us everywhere. He's so illusive."

With Hunt seemingly adamant in his opposition of negotiations, and the doctors equally steadfast in their opposition to his new contract, it seems the dispute could continue well into the summer and become increasingly messy.

Crucial is the question of whether or not the BMA would support more strikes beyond the ones planned for this week. "Part of the government's strategy, I think, is hoping that the BMA will implode in time," says Dr Hammond. "The government know the BMA is divided and it has always been divided… If the junior doctors were to announce an indefinite strike, the top of the BMA would buckle and they'd announce they don't agree with it."

Facing down the BMA would be its own reward for Hunt, suggests Hammond. "Hunt is coming to the end of his reign and he wants to go out with a bang… in terms of his future political ambitions, showing he's toughed it out with the BMA and, within his own party – it makes him look tough."

But he can't rely on beating the BMA alone. Five junior doctors have launched a judicial review against the health secretary. Calling themselves Justice for Health they are challenging his claim that he can impose the contract on the doctors against their will. "We're saying to Hunt: you don't have the authority to impose a contract change; your powers to make such major changes to the NHS were devolved to the organisation itself in 2012 under the Health and Social Care Act," says Dr Francesca Silman, one of the five doctors launching the challenge.

Justice for Health found that the majority of doctors in the NHS are not employed by organisations that Jeremy Hunt actually controls. Hunt's decision to close Lewisham hospital's A&E and other services in 2012 was challenged in a similar way, Dr Silman says. "He lost in the High Court because he didn't have the legal power to make that decision." The current legal challenge to the contract dispute follows similar arguments and so has precedent to be successful. The BMA has also launched a similar legal challenge against the health secretary.

In the longer term, the next major hurdle in the Tory government vs the NHS saga looks to be a similar dispute that could flare up between the government and senior doctors. The government is currently trying to change consultant contracts to make them work a seven-day week as standard. Once again, they're trying to cut consultant pay at the top and the bottom of the scale. These changes are currently being negotiated with the BMA, which is tight-lipped on the progress of the talks.

"[The consultants] strength of support for the junior doctors would suggest that many of them wouldn't accept a new seven-day contract," says Dr Hammond. "Industrial action by the consultants would be a lot more serious if it did happen; it could be a very long and protracted dispute."

The junior doctors strike has happened without causing some sort of dire medical emergency so far because the senior doctors have covered them, so a strike by consultants over similar contract changes could be very messy indeed, and seems inevitable if the government attempts to impose a similar contract. Looks like those tabloid scare stories could be a less distant prospect than we thought.

@owebb

More from VICE:

Understanding the Junior Doctors' Contract and How it Will Affect Us All

Meeting Doctors and Patients on the Front Line of the Junior Doctors Strike

Asking People Coming Out of Hospital What They Think of the Junior Doctors Strike