The government's "final" contract offer to junior doctors in England has been rejected
The British Medical Association said the offer, which included a concession on Saturday pay, was not enough
Ministers are now expected to announce they will impose a contract on doctors
A second 24-hour strike over pay and conditions ended at 08:00 GMT
About 3,000 operations have been cancelled as a result of the action
That's the end of our rolling coverage on the junior doctors' 24-hour strike, and Health Secretary Jeremy Hunt's decision to impose a version of the contract on doctors following an end to the negotiations.
Jeremy Hunt: "They [the BMA] haven't been willing to sit round and talk constructively about this."
He told the BBC that "feelings have become so inflamed".
He said: "I hope that junior doctors will notice today that although I have taken the decision to move ahead with a new contract, I could have moved ahead with any version of that contract I wanted.
"I have actually chosen a version of the contract that has moved a long way to address the concerns that they [junior doctors] and the BMA raised."
Jeremy Hunt tells the BBC: "The truth is, in the situation we are in, there are risks with any course of action."
Norman Smith
Assistant political editor
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Health Secretary Jeremy Hunt said in the Commons that the average basic pay rise was 13.5%.
This is more than we have previously reported - which was 11%.
The Department of Health says after all the tweaks and changes to the contract they have run a re-calculation and it now comes out as an 13.5% average rise.
Image source, BCDr Nadia Masood, a junior doctor, told the BBC she had “absolutely no faith in anything the health secretary did”.
“This is not a quibble about pay or Saturdays or anything like that, this is an issue about a contract that is safe for the future, a contract that works for the doctors and the nurses and all the health care staff that are working every day of the week, every day of the year to keep patients safe.
“This contract will not allow us to do that.”
Hugh Pym, BBC health editor
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Image source, PAMr Hunt said the negotiations had illustrated issues around the well-being and quality of life of junior doctors "which need to be addressed".
He said: "These issues include inflexibility around leave, lack of notice about placements that can be a long way from home, separation from spouses and families and sometimes inadequate support from employers, professional bodies and senior clinicians.
"I have therefore asked Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, alongside other senior clinicians to lead a review into measures outside the contract that can be taken to improve the morale of the junior doctor workforce."
The British Medical Association said junior doctors "cannot and will not accept a contract that is bad for the future of patient care, the profession, and the NHS as a whole".
Dr Johann Malawana, BMA junior doctor committee chairman, said: “The decision to impose a contract is a sign of total failure on the government’s part.
"Instead of working with the BMA to reach an agreement that is in the best interests of patients, junior doctors and the NHS as a whole, the government has walked away, rejecting a fair and affordable offer put forward by the BMA.
"Instead it wants to impose a flawed contract on a generation of junior doctors who have lost all trust in the health secretary.
“This is clearly a political fight for the government rather than an attempt to come to a reasonable solution for all junior doctors.
"If it succeeds with its bullying approach of imposing a contract on junior doctors that has been roundly rejected by the profession it will no doubt seek to do the same for other NHS staff.
“It is notable that the rest of the UK has chosen a different, constructive path on junior doctors’ contracts with only the health secretary in England choosing imposition over agreement.
“The government’s shambolic handling of this process from start to finish has totally alienated a generation of junior doctors – the hospital doctors and GPs of the future, and there is a real risk that some will vote with their feet."
Quote Message“Our message to the government is clear: junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.”
Johann Malawana, BMA
Mr Hunt said the changes will allow an increase in basic salary and that three quarters of doctors will see their pay rise.
Under the new contract, the maximum number of hours doctors will be asked to work in a week will be reduced from 91 to 72 and the number of consecutive night shifts will be reduced from seven to four.
However, junior doctors working on Saturdays will be paid "plain time hours" between 07:00 GMT and 17:00 - although those working one in four or more weekends will receive a 30% premium.
Mr Hunt added that his strong preference was for a negotiated solution but that the BMA had been unwilling to negotiate.
He said the government had been forced to act because "no government or health secretary could responsibly ignore the evidence that mortality rates are higher at the weekend".
He said the government would set up a review, to be led by Dame Sue Bailey, in to measures to improve the morale of junior doctors.
Mr Hunt told the Commons: "He [Sir David Dalton] has asked me to end the uncertainty for the service by proceeding with the introduction of a new contract that he and his colleagues consider both safer for patients and fair and reasonable for junior doctors. I have therefore today decided to do that."
Shadow health secretary Heidi Alexander described it as the "biggest gamble to patient safety the house had ever seen".
Dr Maureen Baker, chairwoman of the Royal College of GPs, said: “We are shocked and dismayed at the government’s decision to impose a contract on our dedicated and committed junior doctors.
“Imposing a deal on junior doctors is wrong-headed, will inevitably damage morale across the NHS – and may damage patient care.
“We had hoped that ministers would ensure an agreement could be reached in a professional and amicable way, so that the two sides could bridge their differences in a constructive manner.
“We would ask whether the government has carried out a structured and robust risk assessment, along with measures to evaluate the impact of their decision on patient safety."
Quote Message“The imposition of the contract will undoubtedly impair our efforts to recruit thousands of additional doctors into the NHS over the coming years in order to keep the health service sustainable – as many medical students are seeing this turmoil, not liking what they see, and turning away from medicine in the UK altogether."
Dr Maureen Baker, Chairwoman of the Royal College of GPs
Andrew Foster, chief executive of Wrightington, Wigan & Leigh NHS
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Hunt tells the Commons that a previous Labour government caused many of the difficulties which contributed to the dispute.
He said he would "not be lectured" by Labour.
Dealing with the accusation that the Tories had conflated the junior doctor issue with seven-day NHS care, Mr Hunt dismissed this.
He said the NHS had "made great strides" since he had been in charge and that avoidable harms in hospitals had nearly halved.
"The Conservatives now are the true party of the NHS," he added.
Ms Alexander has accused the health secretary of acting as a "recruiting agent for Australian hospitals".
She wants Mr Hunt to explain what legal advice he has taken before imposing a contract.
She said that Mr Hunt's analysis of higher mortality rates at the weekend is a "massive over simplification".
She said there is no evidence a lack of junior doctors specifically causes that death rate.
"Imposing contract is a sign of failure," she said.
Labour's shadow health secretary Heidi Alexander said imposing a new contract would "destroy morale which is already at rock bottom".
She said it would lead to a "protracted period of industrial action".
Hunt said that 90% of the sticking points have been worked through with the BMA.
He said he believed in time the new contract would "command the confidence" of doctors.
Jeremy Hunt says he is now imposing the contract.
He said that normal working hours will be from 07:00 GMT to 17:00 on Saturdays
Doctors working one in four or more Saturdays will receive a pay premium of 30%.
He said his "strong preference" was for negotiation, and the governments "door remained open for three years".
Jeremy Hunt said the BMA had refused "point blank" to negotiate.
Nick Triggle
Health Correspondent
In theory, it's pretty easy. Junior doctors rotate through jobs quickly so within six months of the new contract coming into force in August 80% of medics would be on it.
Between now and then hospitals will have to review their rotas and staffing requirements, before sending out offers to junior doctors in May.
But the big unknown is how the British Medical Association and medical workforce will react. Behind the scenes there has been talk of more strikes, mass resignations and non-signing of the contract.
Doctors have also warned of "brain-drain" with medics heading abroad, to other parts of the UK or into other sectors, such as the drugs industry. This, it seems, is unchartered territory - imposing a whole new contract on doctors is thought to have never been done before.