That's the end of our rolling coverage on the junior doctors' 24-hour strike, and Health Secretary Jeremy Hunt's decision to impose a version of the contract on doctors following an end to the negotiations.
Reaction to junior doctors' dispute
- The government's "final" contract offer to junior doctors in England has been rejected
- The British Medical Association said the offer, which included a concession on Saturday pay, was not enough
- Ministers are now expected to announce they will impose a contract on doctors
- A second 24-hour strike over pay and conditions ended at 08:00 GMT
- About 3,000 operations have been cancelled as a result of the action
Jeremy Hunt: "They [the BMA] haven't been willing to sit round and talk constructively about this."
He told the BBC that "feelings have become so inflamed".
He said: "I hope that junior doctors will notice today that although I have taken the decision to move ahead with a new contract, I could have moved ahead with any version of that contract I wanted.
"I have actually chosen a version of the contract that has moved a long way to address the concerns that they [junior doctors] and the BMA raised."
Jeremy Hunt tells the BBC: "The truth is, in the situation we are in, there are risks with any course of action."
Assistant political editor
Health Secretary Jeremy Hunt said in the Commons that the average basic pay rise was 13.5%.
This is more than we have previously reported - which was 11%.
The Department of Health says after all the tweaks and changes to the contract they have run a re-calculation and it now comes out as an 13.5% average rise.
Dr Nadia Masood, a junior doctor, told the BBC she had “absolutely no faith in anything the health secretary did”.
“This is not a quibble about pay or Saturdays or anything like that, this is an issue about a contract that is safe for the future, a contract that works for the doctors and the nurses and all the health care staff that are working every day of the week, every day of the year to keep patients safe.
“This contract will not allow us to do that.”
Mr Hunt said the negotiations had illustrated issues around the well-being and quality of life of junior doctors "which need to be addressed".
He said: "These issues include inflexibility around leave, lack of notice about placements that can be a long way from home, separation from spouses and families and sometimes inadequate support from employers, professional bodies and senior clinicians.
"I have therefore asked Professor Dame Sue Bailey, president of the Academy of Medical Royal Colleges, alongside other senior clinicians to lead a review into measures outside the contract that can be taken to improve the morale of the junior doctor workforce."
The British Medical Association said junior doctors "cannot and will not accept a contract that is bad for the future of patient care, the profession, and the NHS as a whole".
Dr Johann Malawana, BMA junior doctor committee chairman, said: “The decision to impose a contract is a sign of total failure on the government’s part.
"Instead of working with the BMA to reach an agreement that is in the best interests of patients, junior doctors and the NHS as a whole, the government has walked away, rejecting a fair and affordable offer put forward by the BMA.
"Instead it wants to impose a flawed contract on a generation of junior doctors who have lost all trust in the health secretary.
“This is clearly a political fight for the government rather than an attempt to come to a reasonable solution for all junior doctors.
"If it succeeds with its bullying approach of imposing a contract on junior doctors that has been roundly rejected by the profession it will no doubt seek to do the same for other NHS staff.
“It is notable that the rest of the UK has chosen a different, constructive path on junior doctors’ contracts with only the health secretary in England choosing imposition over agreement.
“The government’s shambolic handling of this process from start to finish has totally alienated a generation of junior doctors – the hospital doctors and GPs of the future, and there is a real risk that some will vote with their feet."
“Our message to the government is clear: junior doctors cannot and will not accept a contract that is bad for the future of patient care, the profession and the NHS as a whole, and we will consider all options open to us.”
Mr Hunt said the changes will allow an increase in basic salary and that three quarters of doctors will see their pay rise.
Under the new contract, the maximum number of hours doctors will be asked to work in a week will be reduced from 91 to 72 and the number of consecutive night shifts will be reduced from seven to four.
However, junior doctors working on Saturdays will be paid "plain time hours" between 07:00 GMT and 17:00 - although those working one in four or more weekends will receive a 30% premium.
Mr Hunt added that his strong preference was for a negotiated solution but that the BMA had been unwilling to negotiate.
He said the government had been forced to act because "no government or health secretary could responsibly ignore the evidence that mortality rates are higher at the weekend".
He said the government would set up a review, to be led by Dame Sue Bailey, in to measures to improve the morale of junior doctors.
Mr Hunt told the Commons: "He [Sir David Dalton] has asked me to end the uncertainty for the service by proceeding with the introduction of a new contract that he and his colleagues consider both safer for patients and fair and reasonable for junior doctors. I have therefore today decided to do that."
Shadow health secretary Heidi Alexander described it as the "biggest gamble to patient safety the house had ever seen".
Dr Maureen Baker, chairwoman of the Royal College of GPs, said: “We are shocked and dismayed at the government’s decision to impose a contract on our dedicated and committed junior doctors.
“Imposing a deal on junior doctors is wrong-headed, will inevitably damage morale across the NHS – and may damage patient care.
“We had hoped that ministers would ensure an agreement could be reached in a professional and amicable way, so that the two sides could bridge their differences in a constructive manner.
“We would ask whether the government has carried out a structured and robust risk assessment, along with measures to evaluate the impact of their decision on patient safety."
“The imposition of the contract will undoubtedly impair our efforts to recruit thousands of additional doctors into the NHS over the coming years in order to keep the health service sustainable – as many medical students are seeing this turmoil, not liking what they see, and turning away from medicine in the UK altogether."
Hunt tells the Commons that a previous Labour government caused many of the difficulties which contributed to the dispute.
He said he would "not be lectured" by Labour.
Dealing with the accusation that the Tories had conflated the junior doctor issue with seven-day NHS care, Mr Hunt dismissed this.
He said the NHS had "made great strides" since he had been in charge and that avoidable harms in hospitals had nearly halved.
"The Conservatives now are the true party of the NHS," he added.
Ms Alexander has accused the health secretary of acting as a "recruiting agent for Australian hospitals".
She wants Mr Hunt to explain what legal advice he has taken before imposing a contract.
She said that Mr Hunt's analysis of higher mortality rates at the weekend is a "massive over simplification".
She said there is no evidence a lack of junior doctors specifically causes that death rate.
"Imposing contract is a sign of failure," she said.
Labour's shadow health secretary Heidi Alexander said imposing a new contract would "destroy morale which is already at rock bottom".
She said it would lead to a "protracted period of industrial action".
Hunt said that 90% of the sticking points have been worked through with the BMA.
He said he believed in time the new contract would "command the confidence" of doctors.
Jeremy Hunt says he is now imposing the contract.
He said that normal working hours will be from 07:00 GMT to 17:00 on Saturdays
Doctors working one in four or more Saturdays will receive a pay premium of 30%.
He said his "strong preference" was for negotiation, and the governments "door remained open for three years".
Jeremy Hunt said the BMA had refused "point blank" to negotiate.
In theory, it's pretty easy. Junior doctors rotate through jobs quickly so within six months of the new contract coming into force in August 80% of medics would be on it.
Between now and then hospitals will have to review their rotas and staffing requirements, before sending out offers to junior doctors in May.
But the big unknown is how the British Medical Association and medical workforce will react. Behind the scenes there has been talk of more strikes, mass resignations and non-signing of the contract.
Doctors have also warned of "brain-drain" with medics heading abroad, to other parts of the UK or into other sectors, such as the drugs industry. This, it seems, is unchartered territory - imposing a whole new contract on doctors is thought to have never been done before.
Rachel Clarke, a junior doctor in Oxford, said as a result of Jeremy Hunt's actions she may no longer stay in the medical profession.
She says: "I don't think there is a single junior doctor in my hospital that is not firmly resolved to strike for as long as it takes."
But she warned there were worse consequences than simply industrial action.
"Imposing this contract is going to drive junior doctors out of the NHS," she said.
"I know directly myself of many junior doctors in my trust who have already accepted jobs in Australia who are poised to resign today if this contract is imposed.
"It's a catastrophe for the NHS."
Chief negotiator Sir David Dalton, who was brought in by ministers to try and broker a deal, has given an interview to the BBC.
He said: "I met with the BMA on Tuesday and I put to them the best and final offer.
"I said very clearly to the BMA leaders that this would be the final position and they needed to respond to that.
"We set a deadline and that wasn't met, so I have to conclude that we have reached the end of road of negotiations now, and therefore have advised the Secretary of State that we in the health service should not continue with the disruptions that come from uncertainty.
"He should take whatever steps are necessary now to introduce the contract."
He described the final offer made by the government as "substantial".
NHS England chief executive Simon Stevens has said that drawn out industrial action would cause "disruption to patients who are relying on NHS care", and that the NHS is "right" to say a contract should be now implemented for junior doctors.
Assistant political editor
Labour have warned Jeremy Hunt that imposing a new contract on junior doctors could lead to months of industrial action in the NHS.
They warn the move could also undermine Mr Hunt's efforts to introduce a seven-days-a-week NHS.
Labour say Mr Hunt should continue with the current negotiations in order to try and reach a negotiated agreement.
They say by imposing the new contract Mr Hunt risks jeopardising talks with the consultants who are central to guaranteeing a seven-days-a-week NHS.
The consultants are also represented by the BMA.
"The BMA will be in no mood to compromise," said a Labour source.
They also predict the move to impose a contract will lead to more junior doctors leaving the NHS.
The British Medical Association says it will not be making any formal response over the junior doctors contracts until after Health Secretary Jeremy Hunt has made his statement in the Commons.
Prof Chris Ham is the chief executive of the think tank, The King's Fund. He told BBC Radio 4 that no government has ever previously imposed a contract on junior doctors, and to do so would be a "huge risk".
He said: "As long as that public support for junior doctors remains in place, the government has an uphill struggle to persuade the public it's doing the right thing at the right time.
"Nobody argues against seven-day working. But there's a really important discussion to be had about, will the junior doctors' contract really help that - or are other things far more important?
"So the government really is entering very dangerous territory."
Assistant political editor
Sir David's letter continues: "Both parties have acknowledged that there are underlying issues which, over a number of years, have created the conditions for doctors in training to feel a high level of discontent.
"I wish to confirm my recommendation to you that an urgent review of these long-standing concerns should be established which can make meaningful recommendations to improve the welfare and morale of trainees."
In his latest letter to Jeremy Hunt, Sir David says: "I therefore advise the government to do whatever it deems necessary to end uncertainty for the service and to make sure that a new contract is in place which is as close to the final position put forward by the BMA yesterday."
Ministers are expected to impose a contract on junior doctors later.
It comes after chief negotiator Sir David Dalton advised the government to do "whatever it deems necessary" to end the deadlock and "uncertainty for the service".
A new letter from Sir David Dalton to Health Secretary Jeremy Hunt has just been made public.
The BMA rejected a "final take-it-or-leave-it" offer made by the government on Wednesday, which included a concession on Saturday pay.
This letter, which was sent yesterday, outline's the BMA's response to the offer.
Dr Johann Malawana, chairman of the BMA junior doctors' committee, shows the union disputes the government's claim the BMA never made an offer to try and resolve matters.
In case you missed it here is the letter Sir David Dalton sent to BMA with a final "take-it-or-leave-it" contract offer.
Sir David is the hospital boss brought in last month by ministers to try and broker a deal.
A 24-hour strike by junior doctors in England has now ended - but no deal has been reached in the dispute over contracts.
Doctors' leaders have rejected the latest offer, so will the government impose its contract?
Will Jeremy Hunt do "what he said he would do" if doctors rejected the final contract offer, BBC news correspondent Dan Johnson asks.
Our correspondent says it would be "controversial and unpopular" to impose the contracts on junior doctors, but it's what Mr Hunt said he would do - so "all eyes" are on the health secretary.
Dr Johann Malawana, chairman of the BMA's junior doctor committee, says the contract on offer shows the government is "still not listening".
“Rather than acknowledging junior doctors’ concerns from the start, Jeremy Hunt has attacked and patronised them and rejected a fair and affordable offer put forward by the BMA," he says.
He says the BMA's "door remains open", adding: "The health secretary can end this dispute, but he must put politics to one side and concentrate on agreeing a fair contract that deliver for patients, junior doctors and the NHS in the long run.”
If the government imposes a new contract, it poses "very big questions" for both ministers and doctors, BBC political correspondent Chris Mason says.
Ministers will wonder where such a move would "leave their relationship with doctors, who could potentially still strike further", he says.
Meanwhile he says doctors will wonder if they will "hold on to public opinion" if they continue with industrial action.
"Talks took place within government last night and with senior managers in the NHS about imposing a contract on junior doctors following rejection of final offer," BBC health correspondent Nick Triggle says.
"An announcement on imposition may even come today."
The strike by junior doctors has been debated by commentators in some of the national newspapers. Writing in the Guardian, Simon Jenkins says the cause of the strike is the government's attempts to remedy "disastrous reforms" brought in by the last Labour government.
He adds the NHS requires "tough love":
In the age of the internet and computerised testing, archaic demarcations between GPs, consultants, nurses, pharmacists and technicians make no sense. This is not a matter of ideology, but of restrictive practice. It must cost billions.
The Daily Telegraph
The Telegraph's editorial comment says the strike "goes to the very heart of the debate over the future of the NHS". It argues the walkout went ahead because last-ditch talks collapsed over doctors' Saturday pay - not because of safety fears over the government's new contract. It argues that shows the dispute is now about "funding, not about safety".
With ever increasing seven-day demand, it is clear that new models for financing the nation's health provision must be found. Whether it likes it or not, the BMA has - at last - admitted as much by proceeding with strike action on the ground of cash alone.
Here is the full letter to the BMA from Sir David Dalton, the hospital chief executive brought in by ministers last month to broker a deal in the dispute. In it, he says the last offer to the union was final and that if rejected it would mean there was "no realistic prospect of a negotiated agreement" .
Junior doctors' leaders have rejected a "final take-it-or-leave-it" offer made by government to settle the bitter contract dispute in England, writes the BBC's health correspondent Nick Triggle. The offer included a concession on Saturday pay, but the British Medical Association said it was not enough. The development is expected to lead ministers to announce that they are going to impose a contract on doctors. Read the full story here.
Deana Murphy, from London, tells the BBC her double mastectomy was cancelled this week, an operation she has been waiting almost a year for.
"It's a massive surgery and I know that I could get ill at any time. I think it's important that the public know about what an impact it has when such a big operation is cancelled.
"I am told over and over again urgent cases have to go in front of me. I was told yesterday that the surgery booked for the 17 February has now been cancelled AGAIN. This has been blamed on the doctors' strikes ricocheting into the system. I am devastated my surgery has been cancelled."
Junior doctors from Colchester General Hospital are sending in pictures from their pickets to BBC News.
At Royal Derby Hospital in the East Midlands, 376 outpatient appointments were cancelled today and 37 patients did not get the operations they were waiting for.
Dr Sam Thacker - one of the junior doctors striking in the city - says the action was not intended to cause damage, rather to raise awareness.
"If we, as doctors, did not stand up for what we believe in, then we are doing a disservice to the public," he tells BBC News.
It would be a catastrophe if the government were to impose the current contract, he adds.
The BBC understands the government is set to announce a review of junior doctors' training in England, covering areas outside of the contract negotiations. This will mark a recognition of concerns about how training is organised, says BBC health editor Hugh Pym.
It follows a recommendation by the government's main negotiator, Sir David Dalton, in a letter published last week that " the government, the Academy of Royal Colleges, Health Education England and NHS Employers commission a review of the long-standing concerns with recommendations to all parties for action which can improve the welfare and morale of trainees".
The government is thought to be inching closer to imposing a contract on junior doctors. Sir David Dalton, the hospital boss brought in to broker a deal last month, met with the British Medical Association yesterday but the meeting finished with little prospect of a deal being possible and there are now suggestions an announcement on imposition could come as early as this week.
Northern Ireland's Health Minister Simon Hamilton said: "Our junior doctors deserve a contract which is fair to them and which recognises the key role they play.
"Strike action across the water is regrettable. I have made clear before that an imposed contract would be the worst possible outcome.
"I value the work of our junior doctors in Northern Ireland too much to threaten them with the enforcement of a new contract, but their representatives too must ensure every opportunity is taken to agree the final outstanding issues to replace the existing contract everyone has agreed is not fit for purpose."
In Cambridge protesters and the public are being encouraged to sign a long scroll to pledge their support against the contract.
Gaby Bainbridge from Leeds has had her operation postponed.
She told the BBC: "I have been waiting for surgery for over three months having suffered a pelvic condition for over a year.
"My pelvic dysfunction has been getting significantly worse in the last few months, now at the point where I am unable to walk without crutches, I am unable to carry out day to day tasks, I am unable to work and unable to drive.
"All of this is starting to have an effect on my mental health as although I live with my partner, he works, so the vast majority of the day I am stuck in the house on my own, as my family live a couple of hours away.
"I called my consultant's secretary yesterday who informed me that my operation will not go ahead until March but they are unable to give me a date at this time."
"I am clearly very frustrated about the effect this strike is having on my care and the care of others in similar situations. However, I also support the strikes of the junior doctors and the reasons for it. I just hope that discussions with the government will resume to a more fruitful conclusion to avoid similar actions being taken again."
NHS England has issued an update on the industrial action by junior doctors that is taking place today.
Trusts have reported that 43% of junior doctors - out of a possible 26,000 working on a typical day - have reported for duty on the day shift today.
NHS England confirmed that the 43% figure included doctors who had never intended to strike, such as those working in emergency care.
Combining junior doctors, other doctors and consultants, the data shows 72% of the total trust workforce are in work today.
Over the weekend, NHS England estimated the following operations have been cancelled as a result of the industrial action:
- 1,150 - inpatient ops including 1,036 cancelled on the day they were supposed to take place
- 1,734 day case ops including 1,634 on the day of action
Dr Anne Rainsberry, national incident director for NHS England, said: "It is deeply regrettable that this strike has disrupted care for thousands of patients at the most pressurised time of year and we apologise to anyone affected.
"It's a tough day but the NHS is pulling out all the stops, with senior doctors and nurses often stepping in to provide cover."
"We are actively monitoring the situation across the country and the impact of the action is broadly in line with what we were expecting."
NHS trusts are now working hard to reschedule cancelled tests, appointments and operations as soon as is possible, she added.
Johann Malawana, chairman of the BMA's junior doctor committee, has tweeted this video of the NHS "Sing to Survive" choir giving a performance.
Asked if ministers are ready to impose a new contract on junior doctors a Downing Street spokesman said: "We want to get a deal. This has been a long process with four years of talks. It is very unfortunate there's a strike today."
He said the government had put a "very reasonable deal on the table".
With regards to the question of imposing the new contract, the spokesman said: "We're not going to remove that option from the table."
He added: "We've certainly gone the extra mile to try to get a deal on this."