Some of the biggest grievances of junior doctors could be resolved cheaply and easily by the government – and it would be helpful if certain healthcare leaders stayed out of the debate, writes Steven Alderson

On 23 March, the British Medical Association announced the escalation of junior doctors’ industrial action, to include the unprecedented step of a full withdrawal of labour – including from emergency care.

On the same day, in comments preceding this announcement, HSJ quoted Jeremy Hunt as stating that: “The matter is closed”, and “there is no point in further negotiation”.

Mr Hunt’s simple characterisation that ‘’the BMA is brilliantly clever at winding everyone up on social media” betrays an inherent misunderstanding of the nature of the relationships involved

With the two parties so deeply entrenched, there appears little hope for resolution – and yet, with some social media savvy, pragmatism, and an understanding of the issues really at stake, a peace settlement may still be achievable.

Central to this dispute has been the role of social media. Mr Hunt’s simple characterisation that ‘’the BMA is brilliantly clever at winding everyone up on social media” betrays an inherent misunderstanding of the nature of the relationships involved. Rather, on this occasion, it would be fairer to say that social media has been brilliantly clever at winding up the BMA.

As the junior doctors committee of the BMA met to elect their new leader, another junior doctor, Matt Egan, started a petition on change.org. This called on the BMA to support a strike for junior doctors – and was promptly signed by over 90,000 individuals. On this basis, it would have been medico-political suicide for JDC not to ballot.

Similar grassroots-led interventions emerged from Twitter - including #iminworkjeremy, highlighting that junior doctors already work antisocial hours; #rashdecision, ridiculing Mr Hunt’s suggestion that worried parents’ should ‘google’ their child’s rash; and, more recently #mindtherotagap, highlighting on-going staffing issues in hospitals.

Simply, the medical grassroots are very angry indeed and, at present, they are leading their union

Similarly, a Facebook group comprising 60,000 members – the majority junior doctors – coordinated a 20,000-strong march in London; has crowd-sourced £111,000 to fund a judicial review; and led to 320,000 people petitioning the House of Commons to consider a vote of no confidence in the secretary of state. Simply, the medical grassroots are very angry indeed and, at present, they are leading their union.

Some of this frustration stems from the same drivers that underpin the Five Year Forward View (5YFV): rising demand, from an ageing, and increasingly co-morbid, population. Certainly, over the last five years of my own clinical practice, each year has been harder than the year before: our hospitals busier, our patients more complicated, and sicker, and our staff asked to do more-and-more with less-and-less. These issues are well-described in 5YFV, and solutions already sought by our system leaders.

Doctors are shunted from hospital to hospital every four or six months, in an existence more akin to an adolescent office ‘temp’ than a valued professional

In parallel, junior doctors complain of a multitude of apparently minor slights: many feel that training quality has suffered, as the demands of service have grown; post-graduate medical training has become progressively more expensive, and onerous, with the costs (whether mandatory courses, or professional exams) increasingly met by the individual.

Many feel unrecognised and unappreciated by their employing trusts, with individuals shunted from hospital to hospital every four or six months, in an existence more akin to an adolescent office ‘temp’ than a valued professional.

Finally, whilst we are familiar with discussing rising patient expectations with respect to our NHS, we have neglected to notice that our staff are drawn from the same society - and their expectations are similarly changing. Increasingly, doctors are prioritising quality-of-life over professional self-sacrifice, and are keen to access less than full-time training; work and train in smaller, commutable, geographies; and train alongside their partners.

Simply, the NHS may be failing as an employer to recognise and respond to the changing expectations of employees.

On this basis, there is much that can be done to try and win the peace. Many of the minor complaints of our junior doctors could be addressed cheaply, or for free: whether through bulk-purchase of mandatory training courses, longer training placements within particular hospitals, or the facility for medical couples to apply to regions jointly.

Many of these areas would be considered by the Academy of Medical Royal Colleges review of medical morale - recommended by Sir David Dalton, but currently boycotted by junior doctors – but few can be delivered with total cost neutrality, as demanded by Mr Hunt. A commitment to properly tackle, and properly fund, these issues may be cheaper still than protracted industrial action, however.

More pressingly, but similarly cheaply, must come the reconciliation between our leaders, and the medical grassroots on social media. Many senior medical leaders, including HEE’s Ian Cumming, NHS Improvement’s Jim Mackey, and NHS England’s Mike Durkin, have recently weighed into the junior doctor’s contract debate. Unfortunately, few have sought to calm the waters.

Given the stakes, it might befit those at the very top of our health service to follow the advice issued to those of us in clinical practice, on the frontline of our NHS: sometimes it’s best to just apologise, explain what’s happened, and try to put things right – even if it isn’t your fault.

Steven Alderson is a junior doctor, working in anaesthetics and intensive care medicine, and a former National Medical Director’s Clinical Fellow to Health Education England.