Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern

This week the Risk Register is dedicated to the junior doctors’ contract dispute. How was the deal reached, will it be accepted, what’s it all about and what it means for the longer term.

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Shaun Lintern, patient safety correspondent

Blood on the floor

We have an armistice: the guns of the British Medical Association and the Department of Health have fallen silent, after three years of bitter fighting, five strikes and thousands of operations cancelled.

The DH and the BMA have agreed a deal on the new junior doctor contract dispute. Hurrah! But the victory parties are on hold as there is much still to clear up.

The deal was announced last Wednesday afternoon, following 10 days of intense talks mediated by Acas. It delivers for Jeremy Hunt the notional seven day services he wanted (not that this was ever mentioned at the outset three years ago), while providing much needed quality of life enhancements for junior doctors.

And, it offers some intriguing non-contractual proposals for change that could make a real difference to doctors’ lives. The full Acas statement on the deal is here.

It was time to make a deal, whichever side of the dispute you were on.

The BMA, which had long held to its red line on weekend plain time, came to its senses after leading its first ever full walkout of trainee doctors at the end of April. Its strike had delivered huge disruption to patients and division among doctors on whether it was the right thing to do. But although the BMA had succeeded in pushing the issue deep into 2016, the walkout did not persuade the government to back down from imposition.

On the government’s side the dispute was distracting from its wider programme and was personally bruising not just for Jeremy Hunt but for the wider leadership of the NHS. The realistic threat of junior doctors taking a year out of their training or even resigning was becoming a genuine concern.

So we have an agreement, one that appears to deliver major wins for the government and significant but fewer gains for the BMA. The union has rightly said it will put this deal to its membership.

It is far from certain that junior doctors will ratify the deal and if they don’t we can expect the government to revert back to plans to impose the deal.

The question for junior doctors is this: After so much anger against Mr Hunt personally, can they agree a deal that is perceived to give him a victory? Having forcefully argued, for many months, that Saturday is not Tuesday, can they do a deal that makes weekends plain time, even if that’s only for a minority of medics, without losing face?

Many doctors will believe they have shown their strength of feeling but the fighting now has to stop. Whether they are the majority won’t be known until 6 July.

Key ingredients for peace

Unfortunately we will have to wait about two weeks to receive details of the proposed pay points system, a new salary calculator, example rotas and full terms and conditions. This is understandable given the complexities of the contract but it has led to widespread concern and anger from junior doctors. The BMA leaders have done their best to reassure their members.

HSJ has provided a summary of the key points in the Acas agreement which can be viewed here.

The notable ingredients are the extension of plain time across the weekend, new weekend allowances for doctors working more than one in six weekends. There is a slightly reduced basic pay rate and night shift rate but overall improved rest periods and working hours.

The agreement also makes provision for a new accelerated training support offer for doctors who have to take time out of their careers for maternity or caring responsibilities, which helps address some concerns around discrimination and the loss of automatic pay progression. Couples and those with caring responsibilities could also benefit from a review by Health Education England of placements – and trainees who change their specialty could have their pay protected.

Doctors will be required to offer locum work to the NHS on a bank shift before they can go and work for an external agency. This could prove interesting, in that it will be unpopular with some doctors yet politically very difficult to oppose.

Long term damage

It will be some years before we can truly measure the lasting damage done by this bitter dispute. A generation of doctors have been left feeling undervalued and angry – many may leave the NHS. The level of distrust between senior and junior members of the profession has never been greater and governments will have a hard time securing any future agreements from this generation of doctors. Goodwill in the NHS has not been lost – doctors work hard for their patients, not the government. But loyalty to trusts and institutions may have been badly damaged.

One potential remedy has already been shelved. The Academy of Medical Royal Colleges was expected to carry out a review of the wellbeing of junior doctors, but Dame Sue Bailey has confirmed this won’t now go ahead. But there is still a huge amount of ill-feeling in the profession, and for that reason there remains a strong case for such a review being undertaken.