UK Edition
Junior doctors are on the verge of another spell of industrial action, with a string of sustained strikes planned. Medics are withdrawing all but emergency action for two 24-hour periods, from April 6 to 8.
And there will also be a full withdrawal of labour planned between the hours of 8am and 5pm on 26 and 27 April, which will be the first time in the NHS's history that they will refuse to provide emergency cover. Consultants and other medical staff will still be working during the strike.
New figures from NHS England show that more than 5,100 operations have been postponed as a result of tomorrow's industrial action.
NHS England said it was "deeply regrettable" that thousands more operations have been cancelled.
The new strikes will take place from:
- Emergency care only between 8am on Wednesday 6 April and 8am on Friday 8 April
- Full withdrawal of labour between the hours of 8am and 5pm on Tuesday 26 and Wednesday 27 April
What's caused such ire in the medical community? Is it all about pay? How justified is their anger? Read on for all you need to know.
Why are they so cross?
The BMA's junior doctors' committee announced in August that it was withdrawing from talks with the government over proposals for new contracts, which they said involve pay cuts of up to 30 per cent and the slashing of premium rates for doctors working between 7am and 10pm on every day apart from Sunday. The "unfair deals", according to the BMA, risk forcing promising young doctors to "speak with their feet" and go abroad to work. Their anger was such that they announced plans to ballot junior doctors on industrial action, with voting starting on November 5.
The Government has always said that the terms under discussion were not final proposals, but points which were under discussion at the point the union walked away.
What do the current proposals look like?
BMA and Government negotiatiors held talks up to and including the day of the February strike. But as it ended, it emerged that union negoiators had rejected an improved offer. The Health Secretary then said this new deal would now be imposed from August. Jeremy Hunt says three quarters of junior doctors will receive an increase in take home pay, and only 1 per cent see a loss.
In response, the union has announced a series of strikes, and launched a judicial review of the imposition of the contract.
The terms include an average basic salary increase of 13.5 per cent. Doctors would receive time plus 30 per cent for any hours worked between 5pm-9pm on Saturday and 7am-9pm on Sunday, while those working at least one in four Saturdays would receive a pay premium of 30 per cent for all Saturday hours. Three quarters of doctors would receive a take home pay rise, the Health Secretary says.
However, the increase in basic pay is not an increase in overall earnings. Instead, it would offset losses from other changes in the contract, such as the lower earnings attached to working evenings and weekends. Junior doctors have also complained that there is no clarity about what would happen after 2019, when pay protection ends.
What will strike action involve?
Junior doctors make up around half of the medical workforce, so hospitals will cancel most planned operations and outpatients appointments, and attempt to roster as many senior doctors as possible. Patients groups and MPs have cautioned against such action. Dr Sarah Wollaston, head of the Commons health select committee described plans for strike action as "appalling" and "highly unsafe".
Is the dispute all due to the 7-day NHS idea?
Not directly. The dispute dates back to 2012, when the Department of Health called for changes to junior doctors' contracts in order to update terms and conditions that were agreed in the Nineties. Meanwhile, the Coalition Government indicated a determination to improve NHS care at weekends.
Talks with the BMA broke down in October 2014, with the union complaining about the coalition government's "heavy-handed" approach".
In May, in the run-up to the last General Election, David Cameron promised a "truly seven-day NHS" amid warnings that hospitals have higher death rates for patients admitted at weekends. The manifesto commmitment was followed by promises to reform the contracts of consultants and junior doctors to improve levels of cover on Saturdays and Sundays.
Following this, Jeremy Hunt, the Health Secretary said that a new contract would be imposed if agreement could not be reached.
In September, amid increasing anger from junior doctors - especially on social media - the BMA announced its planned ballot, with 98 per cent of those involved voting to strike on a 76 per cent turnout.
How much do junior doctors get paid?
Trainee doctors currently have a starting salary of £22,636 - at Foundation Year 1 (F1) - rising with experience to reach £30,000 within four years. Doctors in specialist training (ST) receive a salary of between £30,002 and £47,175, while those who make the grade can earn up to £69,325. You don't just walk off the street to start as a trainee doctor either, as they are expected to have a medical degree, which can take between five to six years to get.
Junior doctors enjoy a boost to their salary thanks to a complex system of supplements. This means they can earn on average £40,000 in the initial stages of training, according to the Department of Health's estimates, and £56,000 in the later stages.
How does this compare to other starting salaries?
Trainee doctors do not stand out as very well paid among post-university jobs.According to High Fliers research, almost a third of graduate programmes at Britain's leading employers now pay more than £35,000, leaving graduate doctors in the shade.
Junior doctors also have the disadvantage, compared to their peers, of having to study for a few more years, so by the time they start, others in different professions are further up the ladder.
But what about cuts to their pay?
The Department for Health rejects any suggestion that doctors will see reduced pay across the board, stating that the proposals would see average basic salary more than 13 per cent higher than now. The changes will be "cost-neutral", with "no savings being made", the department adds.
However, the changes are complex. An increase in basic pay means increased pensions costs for doctors (as well as gains for them in retirement). Junior doctors say that means many would lose out, once "pay protection" comes to an end in 2019.
Would doctors be put off certain specialities?
The government insists that help is at hand, as it proposes "recruitment and retention premia" for specialities that are hard to recruit to, like Accident and Emergency, general practice and psychiatry.
When will these new contracts come into force?
2016.