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Editorial Friday 2 September 2016: The two places where the junior doctors' dispute could be won

The British Medical Association has gone nuclear in its plans for the next stage of protest against the new contract for 'junior' doctors.

It plans to hold four five-day all-out strikes of junior doctors, at short notice.

Finance directors may be breathing a sigh of relief at the wages to be unpaid, although lost tariff revenue may make the strikes unprofitable anyway.

The thinking behind the BMA action seems to be that if shorter all-out strikes didn't work, longer and more all-out strikes will. This is interesting politics, given that a new Prime Minister is now in place, who has reaffirmed her confidence in Health Secretary Jeremy Hunt.

The argument over the funding and safety of seven-day NHS services has, for the time being, been settled to most observers' satisfaction by the work of Sutton and Meacock.

This goes back to the issue of resources and safety, and the allegedly junior doctors have powerful arguments on their side. The NHS is facing what Nuffield Trust data diva Sally Gainsbury has rightly described as a 'trading gap'.

Where demand outstrips supply, economics and history teach us clearly that either prices will rise (and there is apparently no more money) or supply will be rationed.

The Q1 financials for 2016-17 look encouraging, until you look seriously.

So 'junior' doctors have a strong case to make that the rising demand for junior doctors to work at 'plain time' rates on a Saturday, unmatched by rising supply (and that supply irritated by political cherry-picking of the evidence base), is unlikely to end well.

However, four five-day all-out strikes at short notice seems unlikely to be the way to get the issue sorted. The Government is not going to back down (yet), and the opposition is a bad joke.

The rota Hell
One of 'junior' doctors' key complaints is about bad rotating of their hours. They are quite right to complain about this, particularly since employers with their heads screwed on (including but not limited to Salford, UHB, UCLH and some others) have spotted that 'junior' doctors are a valuable resource in short supply, and consequently don't treat them like shit with bad rotas.

(Amazingly, these trusts tend to have relatively few recruitment issues and low levels of rota gaps. Who knew?)

Were I running the BMA (which thank the Lord I'm not, sir!), this is what I'd do.

The first thing would be an absolute work-to-rule. This is starting to happen across the medical professions already, as I warned back in February. There would have to be workarounds in the interests of patient safety, but that is the art of the highly feasible right there.

The second thing I would do would be to find junior and consultant leaders in every trust who were willing to work with the management, using resources provided from the BMA nationally and also some local funding to fix the rotas.

It is not clear whether bad, last-minute rota-ing is due to incompetence or indifference, but nor is it pertinent. This is a fixable logistical problem. Some have fixed it already: ask them how.

The consequence of this would be to tangibly improve junior doctors' working lives.

That would be a plus.

And it would look proactive and positive in  the only two places where this dispute could ultimately be won: in the long run, and in the court of public opinion.

It would also create a campaigning tool: an up-to-date national map of rota gaps. I would publish this on a monthly basis, owning a regular point in the news cycle. This iterated 'gap map' would make the point unarguably (and with clear infographics) that we lack enough junior doctors in the right specialisms to safely meet need for five-day services. Let alone seven.

That would be a plus.

And it would look proactive and positive in  the only two places where this dispute could ultimately be won: in the long run, and in the court of public opinion.