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Striking out

Still practising

Chris Preece

Tuesday, 29 March 2016

on strike_shutterstock_235402669.jpgThis blog is, hopefully, going to be completely out of date shortly after it goes live.

With any luck it will be an embarrassment, a permanent testament to my folly.

I say this because I want to open with a slightly controversial statement:

The junior doctors’ strikes won’t work.

That isn’t to say that I don’t understand why they’re happening. Far from it, there was a clear mandate for action, and every reason to do so - the junior doctors contract, even in its latest incarnation, is insidious, unfair and most importantly, dangerous. The BMA, and the profession in general, has very few levers, and striking is an immediate way of bringing the message to the public, whilst creating some political noise.

I absolutely get it. So why then am I so adamant that striking isn’t going to work?

I suppose, partly, because it already hasn’t. The BMA’s seen a few concessions, but the Government’s ultimate decision to impose the contract upon the juniors against their will has swapped those small victories for a morale decimating loss. 

It seemed an incredible decision at the time. Poll after poll had demonstrated that public support was firmly behind the doctors – the NHS Choir even scored the Christmas Number One - pushing through contractual changes seemed like political suicide. Even after the decision was made it seemed unlikely it would hold, as those voices of support Mr Hunt had managed to assemble started to rapidly distance themselves from the decision.

Yet, nothing changed. There has been no back-pedalling, no blinking, in fact barely any further comment. As a result the BMA finds itself in the position of having to not only repeat the strikes, but to up the ante, moving to an all out strike later in April (previous action had kept emergency cover intact).

I confess I had been surprised by the Government’s intransigence, wondering if it was driven solely by Mr Hunt’s desire to be “the man who broke the doctors”, and perhaps it is. However a much clearer explanation emerged as a result of the recent Budget fiasco.

“We see benefits as a pot of money to cut, because they don’t vote for us.” 

That’s a quote from Iain Duncan Smith’s now fairly notorious interview with Andrew Marr on the 20th March. It strikes me as being pretty informative from the perspective of the junior doctors dispute. Industrial action, at least within the public sector, relies upon the Government being shamed into action by the force of popular opinion. It hinges entirely upon the fear of losing votes.

Except, we have a Government that’s already written off the votes of the neediest in our society. An out-going member of the cabinet has essentially confirmed that there is very little interest in the welfare of the sick. The BMA is depending upon a voice that simply won’t be heard.

All of which changes the equation entirely. I had regarded the scenario as one elaborate game of chicken – with the Mr Hunt behind the wheel of his shiny Mercedes driving headlong towards the battered ambulance of the BMA, each wondering which one would jump first. It’s clear now that I had got it entirely wrong – Mr Hunt’s not in the car at all, he simply packed it with those he is supposed to represent, and is now watching gleefully as doctors drive headlong towards their own patients. The BMA can either jump, or get irretrievably burnt in the wreckage.

Let there be no mistake – they will be burnt, it’s just not clear how badly. Whilst there was public support for the strikes it was on the proviso that emergency cover would still exist. It’s unclear what position will be taken following an all out strike.

The BMA’s clearly sensitive to this element, with spokespeople going to great lengths to explain that the public won’t be harmed as a result of the action, though this again feels like it’s simply setting up another trap. It’s hard to criticise the Government for not taking action to prevent a strike if they’ve been assured that it will have no negative consequences. Yet when someone, somewhere, claims to have been harmed – irrespective of the truth – it will immediately be held up as evidence that doctors have been foolish at best, and dishonest at worst.

Mr Hunt has calculated that he loses little from further action, whilst the medical profession stands to sacrifice a great deal. All of which has lead me to my original conclusion. The strikes won’t work.

Unless…

If we’re going to have a strike, perhaps we all need to stop being so careful about what we’re saying, and start being a bit more blunt. 

Of course an all out strike might cause harm. When it happens it won’t be the fault of the doctors on strike, who gave more than enough notice that this would happen, and were clear about how it could be avoided. It certainly won’t be the fault of the consultants, nurses, GPs and other health professionals desperately working to fill that void. It will be the fault of the Government, and of all those who have supported their stance.

So let’s stop pretending it’s all going to be OK. Instead let’s start reminding people just who is causing this car crash. Let’s find a way to make them look up from their breakfast, and realise they have no desire to be associated with a Government that regards the sick with disdain.

If we must have strikes, then make them work. 

Please – make me look like an idiot for having ever thought otherwise.

Author's Image

Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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