How ripple effect of doctor row could be toxic

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The ante has certainly been upped in the increasingly acrimonious dispute between junior doctors and the government in England.

Wednesday sees medics stage a walk-out for the third time - with two more stoppages to follow next month - while lawyers prepare a legal challenge to fight the imposition of the new contract.

But while the medical profession busies itself, the government's tactic is relatively simple: it's hoping the whole thing will just go away.

Now that may seem pretty far-fetched given the row has dominated the headlines in recent months.

But there's good reason to think it will succeed. Firstly, the chances of the judicial review the British Medical Association is pursuing actually stopping the imposition is, by all accounts, slim.

And with Europe dominating the media's attention, the government's spin doctors seem pretty confident the issue won't be given the airtime it has had to date.

There's also a belief that as the strikes continue and the backlog of patients waiting for operations rises, public support and the appetite of doctors to continue will drop away.

Ripple effect

What is more, behind the scenes, efforts are being made to get the other two key pillars of the medical profession onside in the drive for more seven-day services.

An announcement on more support for GPs to help pave the way for seven-day services is expected soon, while renewed attempts are being made to reach an agreement with consultants about weekend working (talks have been going on since the autumn).

Of course, the government's chances of success in both areas is by no means guaranteed. But it's not that much of a stretch of the imagination to see how this dispute could slowly fizzle out bit by bit over the coming months before the new contract starts being rolled out from the summer.

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But even if that happens, the government's strategy is incredibly risky.

Why? By winning this battle, ministers could well end up undermining their long-term strategy as the ripple effect of the dispute could be toxic.

It is a point made by Mark Britnell, a man who knows a thing or two about health systems.

He worked in the NHS for 20 years, rising to become one of its most senior executives before leaving in 2009, going on to become head of global health for KPMG.

"It makes no sense," he told me. "Junior doctors will be crucial in making the changes the NHS needs to cope with all the challenges it faces, but they will be demoralised.

"You can't improve services without bringing the staff with you. This could really set the NHS back."

But it is not just about intangible things such as morale and attitude. There is a risk this dispute could have a real impact on the numbers staying in the NHS in England.

Already many junior doctors' posts are not being filled. Last year one in 10 GP trainee posts went unfilled. The situation was little better for A&E and paediatrics.

Even a small increase in these numbers prompted by medics choosing locum work, the pharmaceutical industry or working abroad (or just elsewhere in the UK as the contract is only being introduced in England) has the potential to cause havoc when more and more is being asked of the health service.

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