Junior doctors - peace in our time or a temporary truce?

It's all quiet on the junior doctors' front. The protagonists in this bitter dispute have agreed to sit down for detailed negotiations. Hospitals in England, expecting a strike until late yesterday evening, are running normally albeit with some cancelled operations and out patients appointments. So how long will the talks go on without a war of words erupting in public and what are the chances of success?

The key development after four days of intense discussions under the supervision of the conciliation service ACAS is that the British Medical Association and the Government side feel able to get around a table for substantive talks. That hasn't happened since October 2014. It has taken months of recriminations, protest marches, an overwhelming vote in favour of strikes and three days of planned walkouts to get the two sides to this point. Trust had been eroded and, until ACAS brokered a way forward, neither the BMA nor NHS Employers could conceive of a way of starting negotiations.

So now the serious talking over the fine print of the proposed new junior doctors' contract is getting underway.

Concessions

A detailed memorandum hammered out under the guidance of ACAS has set out the terms of trade for this new round of talks. This is a significant step forward from the megaphone diplomacy and publication of open letters and angry rebuttals which had characterised the acrimonious exchanges of recent weeks.

The BMA feels that one its main concerns in the proposals has been addressed, namely the perceived lack of robust safeguards to prevent junior doctors being made to work excessive hours by trusts. "Contractual safeguards for safety are paramount," says the memorandum, "and we therefore commit to develop a jointly selected and supported guardian role to oversee the hours of work of doctors in training."

For his part, the Health Secretary Jeremy Hunt feels that there are now at least talks over a new contract which he argues will enhance NHS services at weekends. The document thrashed out with ACAS includes these words: "The parties support the commitment to patients to ensure that the quality of care and patient outcomes (including appropriately adjusted mortality rates) are the same every day of the week."

It is a requirement of an ACAS process that participants agree not to air their differences in public. Neither side is crowing over making the fewest concessions. Calm has descended. That may remain the case as the talks process gets underway today and in the next couple of weeks.

Done deal?

But sources close to each side have made clear there is no guarantee of success. The precedents are not favourable - there were two years of talks over a new junior doctors' contract which then broke up in 2014. There is not much more than three weeks before the Christmas holiday period. The BMA has the right to call a new wave of strikes up to January 6th (giving the statutory one week's notice of action no later than January 13th). So there may not be much of a seasonal holiday for the negotiators.

ACAS has done its bit for now. The two sides must see how they get on together without a referee in the room. The ACAS process has helped the negotiators get to know each other and rebuild trust. A lot is now riding on their discussions, not least the ability of the NHS to cope with winter without the possibility of strikes hanging in the air.