Junior doctors' row: Both sides ready to fight on

Striking doctors in central London Image copyright PA

Ministers and doctors have both vowed to fight on as the first all-out doctor strikes in the history of the NHS ended in England without any major problems.

The last two days have seen junior doctors walk out of routine and emergency care in protest against the imposition of new working conditions.

NHS bosses said hospitals had coped "admirably" during the stoppages.

But there looks to be no end in sight to the dispute with doctors' leaders not ruling out more strikes.

Sources at the British Medical Association said they would now spend the coming days and weeks considering their next options.

But they were adamant this would not be the end of the protest against the imposition of a new contract.

Options on the table include everything from a series of rolling strikes to refusing to do vital paperwork. Meanwhile, two legal challenges are still working their way through the courts.

Some doctors have even talked about encouraging mass resignations from the health service.

A source said: "The government is adamant it won't give in, but so are we. Doctors are not ready to back down."

But government sources responded by saying both the Department of Health and Number 10 had made it clear any escalation in strike action would not stop imposition of the contract from this summer.

"The government is confident in its position and we've made that clear to the BMA."

Wednesday's stoppage ended at 17:00 BST, bringing to an end two days of industrial action which saw 78% of doctors who were expected to work not turning up.

But hospitals told the BBC services had run smoothly during the stoppages - some even said it had been quieter than expected - with consultants and nurses covering emergency care.

It meant no NHS trust had to trigger the emergency protocols which allowed them to call for junior doctors to return to work if patients were at risk.

NHS England's Anne Rainsberry said this was down to careful planning in the lead up to the strike - more than 100,000 routine appointments and nearly 13,000 operations were postponed to allow staff to be redeployed.

"We're not going to pretend the last two days have been easy, but the NHS has remained open to business for patients. The health service has coped admirably."

Patients who ended up in hospital reported they had received good quality care.

Liam Walker, 35, from London, said his partner had been well cared for while in labour.

"There are three consultants instead of three juniors," he said. "We've had fantastic treatment."

Retired health visitor Maureen Gaunt, from Dewsbury, West Yorkshire, went to accident and emergency for a dog bite.

"The staff were very welcoming," she said. "I waited no longer than 20 minutes. Even the staff said it was quiet."

Image copyright AFP

But patients who have seen their treatment delayed have spoken about the problems it has caused.

Senior nurse Wendy Ginsing's daughter Hannah, 21, has been waiting for treatment for a brain tumour since before Christmas. She was due to be admitted on Tuesday, but that was postponed.

"Understandably Hannah is devastated and very annoyed about this," her mother said.

But Ms Ginsing said she still supported the junior doctors' action, adding: "I have seen how dangerous sleep disruption in doctors can be."

Why have hospitals coped so well?

There are a variety of factors. The NHS has had five weeks to prepare for these strikes and by cancelling routine appointments and operations in advanced it was able to free up consultants and nurses to work in emergency care.

Consultants have been largely supportive of their junior colleagues - in some cases even encouraging them to go out - and so have been only too willing to make sure services run smoothly.

The increased presence of senior doctors may have actually speed up processes. For example, Milton Keynes Hospital said having more consultants in A&E enabled quicker decisions to be made about what treatments patients needed.

The public also seem to have heeded warnings to stay away unless absolutely necessary. But that doesn't mean hospitals have got away with it. The number of delayed routine treatments - including cancer care - is piling up, while some hospitals fear there could be a spike in demand in the coming days.

Barry Edwards, who has had open heart surgery and had a follow-up appointment and scan postponed, was more critical.

"I am left in a situation of not knowing if my medication is appropriate, if I am on the mend and recovering as I should," he said.

Mr Edwards said he did not support the strike, adding junior doctors were no longer held in great esteem.

Meanwhile, patient groups have warned the accumulation of postponed treatments - nearly 40,000 operations have now been delayed during the whole dispute - is taking its toll and causing harm. Alongside routine treatments, there have been reports of cancer patients facing delays.

The dispute is over a new contract that the government announced in February would be imposed from the summer. This followed the breakdown of talks between the two sides in January.

The contract makes it cheaper to rota doctors on at weekends - something ministers say is needed to improve care on a Saturday and Sunday.

The BMA has argued it is unfair and the NHS needs extra investment to pay for seven-day services.

Before this week's strikes, there had been four walkouts but all involved emergency care being maintained by junior doctors.

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