Another junior doctor strike has come and gone and the government hasn't blinked. It was unlikely that they were ever going to. Jeremy Hunt unilaterally rejected the proposal that NHS employers and the BMA had agreed upon prior to the last strike and then chose to impose the new contract immediately afterwards as a giant two fingers up to the whole medical profession and, in fact, everybody else who cherishes democracy and reason. He considers himself to have won already and will try to ride out the next series of strikes in his characteristically disengaged manner.
The strikes are important because they demonstrate the strength of feeling amongst healthcare professionals who have spent forty years being manipulated, coerced, and denigrated by successive governments and have finally had enough. There is however a flaw at the heart of the BMA strategy of sequential strikes. The problem is that the current generation of Tory ministers were raised suckling at the ideological teat of Margaret Thatcher and, just as she resisted the miners' strikes, so they see it as an almost sacred duty to stand firm against industrial action.
Further to this is the problem that, whilst the strikes threaten to create a crisis for the NHS, the NHS deals with crises from an individual to an institutional level on a daily basis and has done for decades. The NHS is good at crisis management. Doctors themselves scupper the impact of the strikes by the almighty effort of junior doctors who prepare for, and then make up for, any shortcomings in patient care caused by the strike, and by the effort of the consultants and other doctors providing emergency cover during the strike which ensures that patients do not suffer.
So, despite the symbolic importance of the strikes, their political impact is limited. And with each strike that comes and goes, and with each strike that the government ignores, the impact lessens.
The BMA needs to start re-thinking, it needs to find new strategies with which to take on the government. The legal challenge to the contract is a good start but will no doubt be skilfully mired in a swamp of bureaucracy by government lawyers so, in the meantime, junior doctors need to maintain and increase the pressure on Hunt. There are other protests that could run alongside the strikes that may appear less dramatic at first glance but would likely have more political clout. For example, junior doctors could work to rule.
By actually turning up and leaving at the hours dictated by their rotas, junior doctors would effectively withdraw hundreds of thousands of hours of labour every day that the NHS currently gets from them for free. This would rapidly demonstrate just how stretched current resources are and why they can't be stretched any further to satisfy a Tory manifesto soundbite without extra funding or extra manpower.
Junior doctors should also consider withdrawing their labour from the private wards that exist within many NHS hospitals. This would undermine the parasitic profiteering that the private sector currently enjoys at the expense of the NHS. In some hospitals, in some specialties, junior doctors on NHS contracts are taken away from their NHS patients for significant periods of time to care for those receiving private healthcare.
This effort should also include GP trainees who provide countless hours to the GP out of hours services, many of which are now run for profit by private companies such as Virgin Care. These companies keep their costs down by filling their rotas with NHS paid junior doctors and cheap locums, often flown in from abroad. Such a withdrawal of labour may demonstrate to private care providers that healthcare provision is not so lucrative when there is no longer an NHS from which to cream the lowest risk and most lucrative work.
These measures would help, but the real protest must wait till August and junior doctors must maintain their resolve till then and beyond. There must be a co-ordinated and massed refusal to accept this new contract. Junior doctors have many other options than to accept it. The contract is not being imposed in Scotland or Wales, and it is certainly not being imposed in New Zealand or Australia, and England's loss will be else-where's gain. But there are also less drastic options such as taking up research posts or clinical fellowships which stand outside the training schemes and will, in the end, only be of benefit to the future career of the junior doctors. This will require a generation of junior doctors to be bold and committed but without such action there may not be many more generations of NHS doctors to follow.
Hunt has responded to the strikes with aggression and that is all he will understand in return. The BMA needs to up its game.