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Full statements on the strike: NHS Medical Director and GMC Chair

Sir Bruce Keogh is medical director of the NHS in England

Over the next fortnight, junior doctors will be grappling with their consciences as they consider withdrawing emergency cover from every hospital in England. This is a watershed moment for the NHS – and a difficult time for the medical profession.

The current unrest is not just about contracts, but is the culmination of growing frustration over many years about the difficult conditions in which junior doctors work and train, and about the way they are treated and valued by the multitude of organisations that constitute the NHS. They feel disengaged and powerless, and are expressing their frustration through industrial action, with the support of many consultant colleagues.

Whatever the rights and wrongs of this complex dispute, this is a very serious state of affairs, with serious consequences.

First, although there is a fundamental right to withdraw one’s labour, the recent strikes have caused distress, anxiety and confusion for thousands of patients. Hospitals have reported that many thousands of operations have been postponed – and there is no end in sight.

Second, we cannot offer our patients a quality service without the active and enthusiastic involvement of all staff, including junior doctors. They provide an important service and many will become future leaders of the NHS. That is why it is so important to do whatever it takes to rebuild relationships and repair trust. The longer this goes on, the deeper the damage and the longer it will take to fix.

The medical profession is firmly rooted in a strong set of values and a principle of “first do no harm”. Yet as the NHS prepares for the next strike, which is a significant escalation that includes the withdrawal of emergency cover, the consequences will be different, immediate and long lasting. This new action will put additional significant strain on A&E, intensive care and maternity services, particularly in smaller hospitals.

I worry that the withdrawal of emergency cover will put our sickest, most vulnerable patients at greater risk. This challenges the ethical framework on which our profession is founded and runs against the grain of our NHS and our personal and professional values.

Doctors are the most trusted profession. This trust is a privileged gift bestowed on us by society, but it brings responsibilities and expectations. One of these expectations is that we are there when people need us most.

By withdrawing emergency cover, we risk crossing a line, which will irreparably damage this trust and the reputation of our profession. So I encourage every doctor considering withdrawing emergency cover to dig deep and ask whether such action is fair to patients or compatible with the values and privilege of being a doctor.

More importantly, the need to solve all the underlying issues has become increasingly urgent given the cumulative impact of unrest on our NHS. This is a collective responsibility owned by all parties. Everyone has a role to play in resolving the issues. We owe it to our patients.

Professor Terence Stephenson, Chair of the GMC

The decision to withdraw emergency cover and to proceed with a prolonged campaign of industrial action represents a significant escalation of this dispute. Taking thousands of doctors out of emergency frontline care in England is unprecedented and cannot be done without putting patients at greater risk of harm. To suggest otherwise would be a disservice to the enormous contribution made by doctors in training to the care and treatment of NHS patients every day.

Many doctors in training feel alienated, unvalued and deeply frustrated and this extends far beyond the current contractual dispute. There is a pressing need to address these deep-seated concerns. Given our responsibilities for overseeing the education and training of doctors throughout the UK, the General Medical Council is keen to work with all parties to find a way forward that improves the working lives of doctors in training. But we recognise that this will be difficult if the current contractual dispute has not come to an end.

The evidence from medical directors and employers suggests that while the NHS in England has coped well during the action taken so far, it has placed hospitals and other services under even more pressure. More than 24,000 patients have already had their operations cancelled as a result.

The concern now being expressed by NHS organisations is that, in spite of extensive planning and additional support from senior doctors, some hospitals may be unable to provide safe care for all their patients. Care which is deemed safe during the period of industrial action may still result in patient harm – a patient in chronic pain may experience harm each time a pain relieving elective operation is cancelled.

The circumstances facing each doctor will be different and the decision must be based on an assessment of their individual situation. We are not suggesting that industrial action can never be justified but it does become increasingly hard to justify the longer the action goes on, the more intense it becomes, and the more patient care suffers as a result. Before we reach the next day of action, doctors who are thinking about taking part should carefully consider the impact it will have on patients – both the cumulative effect and the additional risks created by withdrawing emergency cover.

At the outset of this dispute we issued guidance to doctors in England. With the planned escalation we are in an unprecedented situation and next week we will be issuing further guidance both to doctors contemplating action as well as to senior members of the profession. Our guidance is based on the fundamental principle that the first concern of every doctor must be the welfare of their patients.

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