Junior doctors: No more strikes, so what next?

It has been a month the British Medical Association will want to forget.

September began with the announcement of escalated action including unprecedented five-day strikes over four months by junior doctors in England.

But barely three weeks later all industrial action has been shelved. After a series of own goals, the organisation will have its work cut out to devise and communicate a new strategy in what it says will be a continuing campaign.

Splits in the BMA were evident when the council endorsed escalated strike action and with much shorter notice than the previous round of strikes.

Opposition to the idea of five-day strikes was voiced by the profession's leadership at the Academy of Medical Royal Colleges and echoed privately by some members of the BMA's council.

It only took a few days of warnings about patient safety from the General Medical Council and the leadership of NHS England for the BMA to think again and scrap the first set of five-day walkouts in mid-September.

Fresh perspective

Continued murmurings about the danger to patients developed in the days leading up to the weekend meeting of the Junior Doctors' Committee (JDC).

But the most likely outcome seemed to be a reduction from five to three or two days for the autumn strikes.

This, it was argued, would enable the protests against the contract to continue with doctors able to satisfy themselves that the NHS was not overstretched.

But it is a newly elected JDC, with some members coming to the table with a fresh perspective on this long and bitter dispute.

It appears that they brought a message that junior doctors around the country, backed by survey responses, were not prepared to continue with any walkouts let alone a longer stretch of industrial action.

It was feared that further strikes would be poorly supported so continuing with the action seemed futile.

Social media reaction

The decision to suspend the strikes came as a surprise. Some junior doctors took to social media to criticise the BMA. One talked of being marched to the top of the hill then back down again.

Another argued that the organisation had no grasp of strategy and lacked the ability to communicate with the membership and a wider audience. Some even talked of leaving to join the Unite union.

But the social media and other reaction does not suggest that junior doctors want to forget about the industrial action, accept the new contract, and get back to focusing purely on clinical practice rather than medical politics.

The BMA has talked of a "range of other actions" to oppose the contract, due to be introduced from 5 October, and has told members it will let them know soon what these actions might consist of.

The contract and its imposition remains unpopular amongst the junior doctor rank-and-file and there seems to be an appetite for a continued campaign.

The doctors know that calling off the strikes removes their main card in this dispute from the table. But they will argue that making patient welfare the main priority allows them to maintain some moral high ground.

Difficult winter

The government has gone out of its way to avoid appearing triumphalist. The Department of Health statement praised the junior doctor leadership for taking the decision to suspend future action.

Ministers, though, are looking for more clarity on the meaning of suspension and whether the door is still open for action such as working to rule.

A judicial ruling on Wednesday will be closely scrutinised by the BMA and the government. It follows the legal action taken by the group of doctors who founded Justice for Health.

Any criticism of Whitehall's handling of the introduction of the contract will be highlighted by the BMA as it continues its political battle.

It will be a difficult winter for the NHS as the services run at full stretch.

Ministers and employers know that a disgruntled medical workforce will make the task of dealing with rising patient demand even harder.

They hope that a collaborative approach over the contract will support morale.

The strikes are off and the rhetoric has been dialled down. Ministers will feel more confident that what they believe is a fair contract can be rolled out more smoothly.

But while the walkouts are over, the dispute is not. It may yet rumble on for some time.