The following message was sent out from the Junior Doctors Committee to all JDr I reproduce it as it was sent to me through the BMA

“Dear All

As we start the last full week before the first ever full withdrawal of labour in this country by junior doctors, it is clear that the government has had weeks if not months to try and avoid next week’s action. Junior doctors cannot have made this more simple for them.

We don’t want to take the action, but if they are going to impose a contract we have little choice left. To avoid industrial action, get round the negotiating table and let’s try and find fair and safe solutions to the problems facing junior doctors.

Last night it was widely reported exactly how overbearing this government and secretary of state is. They grant operational “independence” to organisations in order to shield themselves from blame, however they then order them to impose a contract on a generation of doctors that is so opposed by so many in the NHS.

The government has had ample opportunity to try and prevent next week’s action, and yet made no effort at all to avert it. Despite having done nothing for the last 5 weeks to prevent this, even now all the government has to do is to talk to junior doctors, lift the threat of imposition and negotiate solutions that are fair and safe for the next generation of junior doctors. To not be willing to even talk is extraordinarily high handed.

Please make your preparations this week for next week’s action. We have produced the following guidance so that you know you have done everything you can to ensure that you have fulfilled your professional obligations.,0,0,0,0

We will continue to hope that the government realises that forcing junior doctors into this unprecedented step is a complete failure on the part of government to listen to tens of thousands of frontline staff, that is inexcusable.

Best wishes

Johann Malawana

Chair of the BMA Junior Doctors’ Committee”

His letter today to the Secretary of State can be seen at

Secretary of States response to this issued today


BMA Report Calls For Safeguards Against Fragmented NHS

The independent sector should be subject to the same robust standards as NHS providers and managers must be wary of the health service becoming fragmented, a BMA report says. The association’s first report on privatisation in the health service is published today and calls for Government and health bosses to implement a series of recommendations aimed at protecting the NHS from being destabilised. It also urges commissioners and health chiefs to consider the possible negative effects of privatisation on training and recruitment and says the taxpayer must not be saddled with the costly legacy of private firms leaving contracts, as was the case at Hinchingbrooke Hospital in Cambridgeshire.

BMA council chair Mark Porter said: ‘The NHS exists to provide the highest quality care for its patients. ‘Anyone who doesn’t accept that, or gets in the way of achieving it, should not be allowed near it. ‘That’s true for anyone who works in the health service, and it’s also true for any individual or company providing services within it.

Public domain

‘The BMA believes in a publicly funded, publicly provided health service. But if there have to be independent sector providers, is it not reasonable to ask of them what we would ask of any new porter, nurse or doctor coming to work in the NHS? ‘It’s not our job to support their shareholders. It’s their job to support our shareholders — every man, woman and child in the UK who uses the NHS.’ Several examples of cases in which private involvement in NHS care has led to problems are highlighted in the report, including the problems at Hitchingbrooke, which was taken over by private firm Circle Partnership in 2012 before being handed back to the NHS three years later in special measures and with severe financial pressures. The report also highlights problems at Nottingham University Hospitals NHS Trust, which lost its adult dermatology work to Circle Partnership, leading to consultants leaving the area and the service collapsing. Another example cited comes from West Sussex where commissioners gave a £235 million contract for musculoskeletal services to Bupa – before a study revealed the deal would plunge the local hospital trust into deficit.

As a result of these, and other issues, the BMA is calling for eight recommendations to be enacted:

  • NHS England should collect data on levels of independent sector provision of NHS services by sector.
  • Before any independent sector provider is chosen as a preferred bidder, there should be a thorough impact analysis taken to ensure that the decision will not destabilise existing NHS services or cause disruptions to the patient pathway.
  • During any procurement process that involves an independent sector bidder, CCGs (clinical commissioning groups) should carry out a full risk assessment for what might happen if NHS staff do not wish to TUPE (transfer of undertakings) to an independent sector provider and how this might affect the continuity of service provision.
  • Independent sector providers of NHS services should be subject to the same requirements as NHS providers in relation to transparent reporting of both patient safety incidents and performance.
  • The CQC (Care Quality Commission) should develop a more standardised approach to regulating independent sector providers in line with NHS providers.
  • Safeguards should be introduced to protect NHS patients and services if contracts are terminated early by independent sector providers.
  • The Department of Health should carry out a regular review of admissions from independent sector providers to the NHS to determine the nature and cost of these incidents.
  • The NHS Standard Contract should be amended to include a clause requiring independent sector providers to contribute towards the education and training of the NHS workforce — either financially or by virtue of making available suitable opportunities.

The report reveals that the level of privatisation in the service is still relatively small, with private firms being paid £6.9bn in 2014/15, a 5.4 per cent increase on the previous year. In context, the total NHS budget is currently around £116bn. Despite the figures, BMA members remain concerned — in response to an association survey, more than two-thirds said they are uncomfortable with private firms being involved in the NHS. Dr Porter said: ‘Privatisation remains a major concern for our members because it has seemed to be a thread through the previous three Governments. ‘But one of the key things we’ve discovered is that while members are very concerned about it and it’s penetrated some areas, there’s not the wholesale privatisation of the NHS today that we might have expected. ‘This needs to be monitored carefully and not something that’s brushed under the carpet and forgotten about.’ By Peter Blackburn  15 April 2016 BMA website


Other news items

Interesting article in yesterdays Guardian on line

Nice article on the demise of the Doctors’ Mess in the Comment section of this weeks BMJ amongst other things

 Info From BMA Comms

Coverage continues today in the Mail, Mirror and Independent of the BMA’s report on privatisation. It is also cited in a large number of regional publications. The report warns that increased privatisation of the NHS risks “destabilising” and “fragmenting” health services. Commenting on the findings, BMA council chair, Dr Mark Porter, said: “At a time when the NHS is facing huge financial pressure, more attention needs to be paid to private sector provision of NHS services to assess whether it provides value for money, high-quality, safe care to patients, as well as the impact it has on other NHS services.” He added: “The NHS exists to provide the highest quality care for its patients. Anyone who doesn’t accept that, or gets in the way of achieving it, should not be allowed near it.” Additionally, the report called for private providers delivering NHS services to undergo the same level of CQC regulation as NHS providers with the requirement to deliver training written into their contract so they could be at the “same standard”. Coverage in the Mail reveals that the NHS is being forced to look after an estimated 6,000 patients a year who need NHS care after receiving poor private treatment as the report warns of the financial implications that it will place on an already strained NHS.

Following questioning of the Health Secretary in the House of Commons on the junior doctor contract imposition, the Mirror reports that Labour’s Shadow Health Secretary Heidi Alexander suggested that his motives were more to do with taking on the BMA rather than improving patient care. Additionally, the Guardian reports that Labour have asked Jeremy Hunt to clarify his position on the imposition of the contract as he said he was “imposing” the contract, despite government lawyers and the Department of Health insisting he is playing a key role in its “introduction”.

In other news, the Guardian features a number of case studies from doctors suffering with mental health issues as research from Cardiff University reveals that eight in ten doctors in England have experienced mental health issues.
BMA online

NHS privatisation will damage health services Daily Mail, Monday 18 April 2016,

BMA calls for tighter checks on privatisation of NHS services GP Online, Monday 18 April

Hunt admits imposition is ‘suggestion’ Daily Mirror, Monday 18 April 2016

Health Secretary criticised for backtracking on imposition  Independent, Monday 18 April

NHS forced to deal with private treatment fall out  Daily Mail, Monday 18 April 2016

Labour asks for clarification on contract imposition Guardian, Monday 18 April 2016

Hunt misleading junior doctors?  Channel 4 Online, Monday 18 April 2016

Hunt has no power to impose terrible contract Independent, Monday 18 April 2016

Patients will struggle to see GPs during strike  Daily Mail, Tuesday 19 April 2016,

Hunt pleads with junior doctors not to strike  Daily Telegraph, Tuesday 19 April 2016,

No U-turn on contracts   Daily Mail, Monday 18 April 2016

Doctors struggling with “burnout and depression”  Guardian, Tuesday 19 April 2016

 From the General Medical Council today

Statement about the industrial action by doctors in training in England

GMC Statement

 11 Apr 2016

Professor Terence Stephenson, Chair of the GMC, said:,7ONC,1QW6C,OJVW,1

GMC statement: refusing unsafe rotas

GMC Statement

19 Apr 2016

Following a number of queries via social media, we’ve issued the following guidance to doctors who might be asked to cover rota gaps which they feel they cannot safely cover.

RCR News – Special Issue: Junior doctors’ dispute     Info from UK-CC Member

Junior doctors’ dispute

Dear Dr xxxx

We have today issued a further media statement about the junior doctors’ situation. In our view, the continuing dispute is a reflection of the relentless increases in pressure on healthcare services as evidenced for our specialties by key waiting time targets being repeatedly missed,  backlogs in image reporting and the severe workforce crisis in radiology.
A solution to the contract dispute must be found without further delay and we believe that organisations representing patients can play an important part in this.  As before we urge the Government not to impose the planned new contract on junior doctors and the BMA in turn to call off the all-out strike by junior doctors planned for 26 and 27 April.

Your thoughts and suggestions are always welcome at


Dr Giles Maskell

Royal College of Psychiatrist view can be found at