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High Stakes Poker

16/11/2015 11:02 GMT | Updated 15/11/2016 10:12 GMT

The key developments in the ever-circling whirlpool of the very public and political negotiations concerning a future contract for doctors in training, otherwise known as junior doctors, are outlined below.

Jeremy Hunt Threatens Imposition

Following the walk out from the BMA, Hunt was left with no option but to announce the imposition. With neither side talking, no progress could be made. He already had a contract of sorts, provided by DDRB, and he had a big majority government to back him up. This is his chance to create a legacy and entirely change the profession, something history extensively shows to be nigh on impossible. The outpour of rage from doctors was perhaps not something he banked on, as most read the biased report from DDRB which sides with the government on all but one of twenty three points. The catalyst that fuelled the ensuing debacle.

BMA Announce Ballot

41 years in waiting, the medical profession are facing the very real possibility of industrial action. Buoyed with the swell of unity from doctors the firm stance from Hunt was directly countered by a stark stance from the BMA; you impose, we strike. This battle needs be a lengthy affair, and the BMA needs be the abused underdog. They secured the ongoing media coverage with the unprecedented proposed course of action. However, from nought to sixty with complex reasoning the required perception was not achieved. A fairly clunky handling when compared to the savvy and slick political spin machine.

Jeremy Hunt Declares No Doctor Loses Out

During the tricky opposition day debate, which highlighted all the inadequacies of the proposed contract based on the DDRB report, Hunt drops the revelation that none of the current doctors will lose out financially. The fact he corrected himself the morning after did not matter. He neutralised the debate by manipulating the press coverage to something palpable - money. Not only did he control the media, but also he grew seeds of doubt in the junior doctors' resolve. Divide and conquer. An excellent move.

BMA Confirm Types of Industrial Action To Be Balloted

Mindfully, the BMA proposes 'emergency cover' and 'full walkout'. The former was hideously ineffective and largely denigrated during the pension dispute. The latter is an ethical nightmare for professionals whose sole intention is to act in the patients' best interest. A delicate balance, accompanied by full reasoning and instructions to vote Yes / Yes in an attempt to leave nothing to chance. This is crucial as a strong result shows the discontent amongst medical professionals and the BMA wish it to be their Ace card.

Jeremy Hunt Releases 11% Pay Rise

For me, the turning point. A clear signal the media battle had begun. The morning before the ballot begun, Hunt told the media that doctors reject an 11% pay rise while all other public sectors have been slashed. This paints the profession in a terrible light. Not one to let reality to ruin a headline, this was sensational spin. However, he knew the price of public sympathy would not just be medical anger. Every single junior doctor knows the pay rise to be a fallacy, thus by attacking the doctors he lost trust. This has been further inflamed by use of 'danger money' and 'militant'. Doctors are not politicians and will not write off these tactics as part of the process. They will remember, and they will greet further negotiations with heightened scepticism. Aside from this, by fuelling emotions he knew he was ensuring the ballot result. So the question is; why does Jeremy Hunt want the profession to strike? To detract from the perennial winter crisis? To destroy and privatise the NHS? To flourish a trump card on the river and be the hero? We all love a conspiracy theory, but only time will tell.

BMA Affirm Details of Industrial Action

In a bold and bizarre move, BMA tells the world how they are going to strike - before the ballot closes. Evidently confident, as there could be a catastrophic embarrassment if a majority Yes / Yes vote is not achieved. The apparent benefit in this is to counterpunch the media damning or Jeremy's plan of action before either blow has landed. This gives hospitals the chance to minimalise damage caused by removal of labour, thus putting onus back on to Hunt. The obvious backlash is from the junior doctors themselves. Single day strikes, giving hospitals the chance to cover with more highly trained consultants - what impact will this actually have? Those with aspirations to chant on a picket line for weeks until the government caves in will feel deflated and angry at their own trade union for an ineffective course of action.

Jeremy Hunt Removes Preconditions

By slowly dripping more concessions, Jeremy is coming across like he is trying his best to avert the crisis against unreasonable doctors. To show the public there are no set terms to the negotiations, he has undermined the major reasoning behind the actions of the BMA. Again, a publicity stunt and a delicious bit of spin. He then chooses to caveat the 'free' negotiations with the overbearing prerequisite that he can impose a contract if negotiations are not progressing satisfactorily as he has a mandate to deliver a seven-day NHS. Again, reality not needed as headline and social media storm successful.

Outside Influences

Sarah Wollaston

A key Member of Parliament, both a GP and a Conservative MP - the definition of conflict of interests. Roundly respected by all, she has the impartial voice of reason. From day one has urged both sides to sit and talk. Quite rightly describes the relationship between junior doctors and the government as 'toxic'. Has repetitively stated a strike to be harmful to patients. Useful ally to BMA in early exchanges but has now shown Jeremy Hunt support with her damning of the proposed industrial action.

Royal Colleges

An interesting standpoint. Although politically neutral, several colleges have noted the effect this could have on training - their sole reason of existence. Anaesthetists were the first tentative flag bearers, shortly followed by a joint letter from all colleges urging talks to take place between the two feuding sides. Jeremy Hunt realised the impact these respected institutions could have, requesting to meet the heads. However, this backfired as the Paediatricians have publicly denounced the proposals, soon tailed by Psychiatrists - both of which have severe problems in recruitment and retention. Expect further colleges to nail their colours to respective masts.

So there we have it. The significant actions, the counter punches and the fascinating battle of two sides trying to win public support to deliver polar opposite mandates. Subsequent proceedings will make for groundbreaking history. I await the royal flush.