Jeremy Hunt has admitted there are flaws in the new junior doctors contract in a final plea to call off next week's strike, but stopped short of agreeing not to impose the changes.
From 8am-5pm on Tuesday 26 and Wednesday 27 April, junior doctors will withhold all services, including emergency care, for the first time in NHS history, in response to the health secretary's decision to impose changes to their working hours and pay structure that they believe to be unfair to doctors and patients.
In a letter to Dr Mark Porter, the chair of the British Medical Association (BMA), Hunt urged the doctors union to cancel the strike, which he believes could pose a risk to patient safety.
Consultant doctors, who will provide medical cover in place of junior doctors during the walkout, have repeatedly said patient safety will not be compromised as a result of strikes.
Hunt would not relent on his decision to forcibly impose the contract on junior doctors from August 2016, citing the BMA's refusal to compromise on doctors receiving premium pay on Saturdays, but said "that does not mean that we cannot rebuild trust with further talks on a range of issues that can improve the terms and conditions for junior doctors."
He invited Porter to meet him on the condition that the strike would be halted, and offered to discuss how workforce and funding requirements for seven-day services, continuity of training, the reduction of working hours, work-life balance, and the burden of examination fees could be improved once the new contract was implemented.
Throughout the public dispute over the contract, which has been raging on since last summer, doctors have said their opposition to the new contract is not about pay, but their belief that the new contract would still allow for dangerous shortfalls in staffing, due to the same issues that Hunt highlighted in his letter to Porter.
"It's been clear all along that this dispute is not about Saturday pay, but about ensuring patients are safe and there are enough doctors to look after them," Dr Christopher Gee, a trauma and orthopaedic registrar in Brighton, told BuzzFeed News.
"Hunt has made this clear in his letter to the BMA today," Gee said. "What is needed now is for the government to drop imposition and return to negotiations. Like all junior doctors, consultants, patient associations, and royal colleges, I hope he does."
Last week the Academy of Medical Royal Colleges called upon the government to lift its threat of imposing the contract and reinstate talks with the BMA in return for a cancellation of the strike. "We urge the government to accept this offer," its statement read. "Both sides must show a genuine commitment to reaching a negotiated settlement."
Dr Ben Janaway, a junior doctor in Plymouth, welcomed Hunt's letter. "This is a reassuring step forward from a health minister who has, until now, grossly oversimplified a complex set of issues," he said. "We hope that this admittance of a greater problem, and the potential for negotiation, will lead to us building a NHS safe contract together."
A spokesperson for the BMA confirmed Porter had received the letter and would respond in due course. "The BMA has already made a clear and genuine offer to government, saying if it calls off the imposition, junior doctors will call off next week's action," they added.
Labour's shadow health secretary, Heidi Alexander, has also spoken out against imposition, calling it the "wrong approach [that] risks permanent damage to the future of the medical workforce".
In a cross-party letter to Hunt also signed by doctor and Conservative MP Dr Dan Poulter, SNP MP and surgeon Dr Philippa Whitford, and Liberal Democrat MP Norman Lamb, Alexander suggested that both sides should relent on their decisions to strike or impose and instead agree to a pilot scheme of the contract in a select number of trusts.
When Hunt originally proposed the new contract, he said the changes would tackle a "weekend effect" in which a patient is more likely to die in the 30 days after entering hospital if they are admitted between Friday and Monday.
Hunt has repeatedly been criticised for having no evidence to suggest this increased mortality rate has any connection to junior doctor staffing.
"There have been questions raised about whether changing the junior doctors contract will make any significant impact on the so-called 'weekend effect' as the underlying cause of these deaths has not been identified," Alexander wrote. "The lack of any robust research proving a causal link between junior doctors staffing arrangements and the number of patients who die within 30 days of weekend admission needs to be addressed."
She said an independent evaluation of nursing ratios, access to diagnostic imaging, and consultant cover, alongside a pilot of Hunt's junior doctors contract, would help paint a better picture of how patient safety could be improved.
Hunt accused Alexander of "opportunism" following publication of the letter on Sunday, and said only 11% of doctors would work under the new contract in August.
"We're staging implementation to ensure it works as intended," Hunt tweeted.. "Any further delay just means we will take longer to eliminate weekend effect."
"A pilot in principle is a good idea for any change, but the contract in its current form is not fit for purpose, as we are seeing with trusts trying to adapt their rotas to allow for it," said Dr Ben White, a junior doctor in London who has been involved in launching legal action against the contract.
"Doctors would need to be ethically convinced this contract was non-discriminatory and safe for patients before it could be implemented," he said.
Laura Silver is a reporter for BuzzFeed News and is based in London.
Contact Laura Silver at email@example.com.
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