Junior doctors contract saga - the latest twists and turns

After a dispute over junior doctors' contracts which has rumbled on steadily for a year, there has been a flurry of activity in just a couple of days. The British Medical Association announced it would ballot members over industrial action. The Health Secretary Jeremy Hunt has invited the BMA junior doctors' leader to a meeting. And an open meeting convened for doctors by NHS Employers has been abruptly cancelled.

The events are of course not unconnected. The minute the BMA decided to hold a vote on industrial action ministers were always likely to sit up and take notice. Mr Hunt, it appears, has been away for a few days so a return to the office on the first working day after the ballot announcement was a good opportunity to look again at the contract issue.

Whitehall sources indicate that Mr Hunt is keen to meet Dr Johann Malawana, the new chair of the BMA junior doctors committee. Dr Malawana took on the role on Saturday and his first task was to announce the ballot, describing his members' mood as "incredibly angry". The Secretary of State has every reason to want to meet the new leader, especially one with a mandate for possible protest action.

The Government line is that drawing up a new contract is best done by negotiation and that no firm and final offer has been put in front of the doctors. Although wanting to simplify and amend the contract, sources indicate that ministers have not set out detailed demands over which working hours in the week should attract higher payments.

Junior doctors say they want a contract "fair to both junior doctors and the health service as a whole"

The BMA, however, is adamant that the Government and NHS Employers have demanded preconditions, including treating Saturday as a normal working day like Monday to Friday. That's why the association felt it had no alternative to suspending its involvement in talks. Negotiations stalled in October 2014 and the BMA declined to re-enter talks this summer. The Government then said it would impose a new contract on junior doctors in England from August 2016. The Scottish and Welsh administrations have not gone down the same route.

Mr Hunt, it seems, would rather avoid headlines about doctors working to rule and routine surgery being cancelled. There was a walk-out over pensions as part of a public sector day of action in 2012. But you have to go back to the 1970's for the last time BMA members took disruptive action over pay. Mr Hunt has seen NHS consultants return to the negotiating table over the issue of weekend working. He will hope very much that the junior doctors can be persuaded to enter talks before a ballot takes place.

A roadshow of open meetings for junior doctors planned by NHS Employers has been cancelled. One, planned for Westminster, was axed with less than five hours notice. Ministers had probably concluded that such events would be a magnet for protests witnessed by TV crews and a public focus for junior doctors' anger. But as it was, even after the cancelled meeting at Westminster, a few thousand medics still turned out to take part in a lively demonstration on Monday evening.

Dr Malawana and his colleagues have accepted Mr Hunt's invitation for a chat at the Department of Health. He has made it clear that the ballot and possible route to industrial action will continue unless the Government can give "absolute assurances" sought by the junior doctors. The question now is how far the Secretary of State is prepared to go to get people around the table.

On the face of it the two sides are some way apart. Ministers and NHS chiefs want to create a new contract which rewards higher-achieving junior doctors more than the current system allows with automatic increments. They also want a simplified system of payments for weekends and unsocial hours.

The junior doctors, by contrast, say they could lose up to 30% of their annual pay with the new contract and be pushed into working excessive hours, putting patient safety at risk. They argue that doctors will head for the exit doors and seek employment overseas, leaving the NHS short of qualified staff.

Much, then, hangs on the meeting between Mr Hunt and Dr Malawana. At stake is the possibility of serious talks over contracts or the first industrial action over pay and conditions by doctors in 40 years.