Samir Dawlatly: Junior doctor contract crisis—conspiracy or incompetence?

I fully supported the right of junior doctors to be balloted for industrial action and to take it, if required. I was right behind them using the strongest bargaining chip that they hold in their bid to pressurise the government and NHS Employers into giving them a fairer and safer (for them and patients) deal. I was also convinced that Jeremy Hunt wanted them to strike.

Prior to the strikes being called off, I had believed that the whole junior doctor contract situation had arisen as a part of a larger conspiracy to privatise the NHS by stealth, rather than incompetence on behalf of the government. Given the choice between incompetence and conspiracy, I have to say that I have always half believed that there is a thinly veiled conspiracy. Hunt was in a win-win situation; he always has been. His stated short term aim and desire was to impose a contract of his liking upon the junior doctors in order to achieve the political aim of “routine” seven day working. The imposition of the contract was one of the major obstacles to negotiation with the BMA Junior Doctors Committee. However, Hunt always knew that if the BMA didn’t negotiate with the government over a proposed contract then a contract (of his liking) could be imposed with three months’ notice.

So, it seemed to me that the only way that the BMA could have avoided a contract being imposed was to formally enter into negotiations with the threat of an imposed contract hanging over them. All the government had to do was antagonise the profession enough so that negotiations never started. Et voila! The opportunity to impose a contract anyway would materialise. When one applies this perspective it seems to a conspiracy theorist like me that every action of Hunt may have been planned to inflame the situation and avoid negotiation.

What would have happened if the junior doctor strikes had gone ahead? My thoughts? Nothing. I believed that Hunt would not have changed his stance and would have played chicken with the BMA over subsequent strikes, hoping to break the unity of the profession and get the public on his side. I didn’t expect any conciliatory noises at all. Instead I imagined leaked stories or tip-offs resulting in stories of patients suffering as a result of strike action appearing in the newspapers and weakening public support for the strike.

As alluded to earlier, I had assumed that the imposition of contracts was part of a wider conspiracy theory about preparing the NHS for privatisation. It has been said that the NHS is the closest thing there is to a national religion, a national treasure. In order to get the NHS off the public spending books it has to be “proven” to be broken. And what better way of breaking the NHS than destroying the morale of the hospital workforce, who may choose to quit, emigrate, or carry on begrudgingly with no sense of goodwill, on which so much of what is good about the NHS is built on.

Noam Chomsky has been quoted as saying: “If you want to privatize [sic] something and destroy it, a standard method is first to defund it, so it doesn’t work anymore, people get upset and accept privatization.”

Austerity is defunding the NHS in a financial sense, but the imposition of the junior doctor contract would have been, and could still be, an additional step of sabotaging and arguably “defunding” it of its greatest asset; its workforce.

I presumed Hunt held all the winning cards and was simply playing himself towards the endgame for the NHS. With the avoidance of the strikes it makes me think that perhaps I was wrong and there is no conspiracy theory after all, just incompetence…

Samir Dawlatly is a GP Partner at Jiggins Lane Medical Centre. He is on the management board of Our Health Partnership and co-clinical director of QCAPS referral improvement scheme. All views expressed are his own. He can be found on Twitter as @sdawlatly.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.