Wait now Jeremy, who’s got the detonator?

Jeremy Hunt watching a doctor with a detonator, thinking "they wouldn't dare"
Who’s holding the detonator now, Jeremy?

Jeremy Hunt has declared the matter of negotiation over junior doctors contracts closed. Despite strike action he has refused to enter into a meaningful dialogue with the profession, and he has conducted himself in the manner of a parent, exasperated with the noisy tantrums of a (hopefully now exhausted) child.

As a means for change, British strikes are notoriously ineffectual. We want to protest, but we (rightly) wouldn’t want anyone to be inconvenienced, let alone endangered at our expense.

Our own government too, understand this. A striking workforce is a stressed workforce, and protests falling on deaf ears is demoralising. I’ve grown to admire the conservative government, and the private money which backs them. They understand beautifully how power works, and how the imposition of their so-called nuclear option will break a generation. A subdued and disheartened consultant body is not one which will oppose the sale of contracts and services to private providers.

Junior doctors, well-educated as they might be, have had neither the time nor the energy to consider that Jeremy Hunt is not in the position to impose anything.

Here’s the real nuclear option: we remember that a contract is a just an agreement between parties, each and every doctor in the UK has a choice about signing on the dotted line. I propose that junior doctors write to say that they will not be renewing their contracts on the current terms but will be happy to work out their notice (generally 3 to 6 months). Naturally, these tendered resignations would be reconsidered in the event of renegotiations and a mutually agreed contract.

Doctors, hold the cards and should call the stakes. It might seem high risk, but like with most remarkable changes, it can be achieved with solidarity. A government which cannot provide a health service is not viable: the conservatives (and friends) would do well to be reminded of this.

I know many people will think this is a shocking suggestion, but really, faced with mass resignation and no replacement workforce, the government would have no option other than to re-negotiate. A ticking clock will no doubt sharpen their attention, and in addition, the general public wouldn’t be subjected to the drawn-out process of more sporadic industrial action. Most terrifyingly of all, for the private interests, an emboldened medical profession will be better placed to protect the National Health Service.

Of course there will be a hoopla. In Mr Hunt’s own words, invested parties will be “winding everyone up on social media”. The profession will have to stand strong, as the biggest, nastiest scare tactics all will be cracked out, those strictly reserved for when the power game has been rumbled. But ultimately, doctors should feel reassured, asking themselves, as Jeremy has, “did [we, the medical profession] make the long-term strategic calls necessary to help the NHS offer the highest possible quality of care patients?”.

From the start, the message from junior doctors has been clear: this is bigger than us, and it’s bigger than the money. I believe this, and I think the general public do too. It’s with that support that junior doctors should at least consider their own nuclear option before the government imposes theirs.





I send this to the Guardian on the 9th of August (minus current title and jazzy drawing of Jeremy’s face) who initially said they’d publish it, but then didn’t  – so I’ve updated it to include the recent strikes.

I should say that before working in Spain, I was a junior doctor in the NHS for 10 years (a senior medical registrar when I left) in London and Glasgow. Things have been going pear-shaped for a while, medical politics-wise, and after being involved in/opposed to what was effectively stage one of this dismantling (“Modernising” Medical Careers)  I didn’t actually think the profession was going to stand up for themselves. I’m delighted and relieved that they have, and for the first time in a long time i think the NHS has a fighting chance.


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