Junior doctors have rejected a call by their own leader to keep working in children’s medical units during the forthcoming all-out strikes.
Dr Johann Malawana, the chair of the British Medical Association’s junior doctors committee (JDC), suggested that providing paediatric cover during the strikes was the “right thing to do”, in a private email to the committee on 21 March.
Junior doctors in England are due to stage their first ever all-out strikes on 26 and 27 April as an escalation of their protests against the new contract that the health secretary, Jeremy Hunt, plans to impose. Unlike the four walkouts they have held since January they will not report for duty even in medical settings that provide critical care, such as A&E, emergency surgery and maternity.
In his email to the JDC, obtained by the Health Service Journal, Malawana said: “Having taken a lot of very private soundings and talked to lots of people I am going to suggest that any full withdrawal of labour excludes emergency paediatric services.
“I hope the committee will support me in this decision. I say that from a [communications] perspective and to try and ensure we get the sign-up of [doctors] as well as retaining the reasonable ground, it is the right thing to do.”
Later that day, in a separate email, he said: “The reasoning being that doctors withdrawing care from children would be a difficult line to defend.”
Malawana added that he would be happy to explain how on both strike days consultants would be able to cover for the absence of junior doctors in other areas of care, including childbirth services.
“But I think it also gives the profession more ability to sign up to an escalation and increase participation,” he wrote.
Stressing the need to keep the medical profession as a whole united behind the juniors’ campaign, he added: “Even [doctors] not in the services covered I think would feel more comfortable being able to talk about and point to this as something that demonstrates our absolute desire not to take [industrial action].”
Malawana’s suggestion, and the fact that it was rejected, is a sign of the private differences of opinion within the doctors’ union about the wisdom and potential risks of withdrawing care completely.
Prof Sir Bruce Keogh, NHS England’s medical director, and Prof Terence Stephenson, the chair of the General Medical Council, have warned junior doctors – all medics below the level of consultant – that total withdrawal of cover could wreck public trust in the profession and potentially lead to patient harm.
The BMA insisted that Malawana’s exchanges were part of the JDC’s considerations of its options about how to pursue its industrial action, in which a range of views were put forward. Doctors would rather be talking to ministers than striking, a spokeswoman said.
“As would be expected, junior doctors, of course, considered the full range of options and possible implications before deciding on what course of action to take,” she said.
“No junior doctor wants to have to take any action, they would rather be in hospital caring for patients, but they have already done everything else in their power to make their voices heard. By continuing to ignore them, the government has left them with no alternative.
“The critical message for patients is that anyone who needs emergency care on the days of industrial action will get it, the only difference is that it will be provided by senior doctors rather than junior doctors,” she added.
The BMA called on Hunt to drop his threat to impose the contract and instead resume peace talks, which broke down in February. Hunt, though, has insisted that “the matter is closed” and refused to talk further until the union is prepared to negotiate on Saturdays becoming part of a junior doctor’s normal working week.
