Ministers are to impose a contract on junior doctors in England after a final offer was rejected by the British Medical Association.
Health Secretary Jeremy Hunt said he had been left with no choice after the union refused to compromise.
He said the final deal rejected on Wednesday was an “important step” to improving care at weekends.
Chief negotiator Sir David Dalton had advised ministers to do “whatever necessary” to end the deadlock.
The advice was given in a letter following the BMA decision to reject a “take-it-or-leave-it” deal on Wednesday, which included a concession on Saturday pay.
Speaking in the House of Commons, Mr Hunt said: “He (Sir David) has asked me to end the uncertainty for the service by proceeding with the introduction of a new contract that he and his colleagues consider both safer for patients and fair and reasonable for junior doctors.
“I have therefore today decided to do that.”
But Shadow Health Secretary Heidi Alexander said: “This whole dispute could have been handled so differently.
“The health secretary’s failure to listen to junior doctors, his deeply dubious misrepresentation of research about care at weekends and his desire to make these contract negotiations into a symbolic fight for delivery of seven-day services has led to a situation which has been unprecedented in my lifetime.”
The developments comes just hours after junior doctors concluded a second 24-hour strike at 08:00 GMT in their long-running dispute about pay and conditions.
During the walk-out doctors provided emergency cover, but the stoppage led to the cancellation of nearly 3,000 routine operations and treatments. GP care was largely unaffected.
The contract offered by the government would have seen those working at least one in four Saturdays get extra pay for each one they work. The move represented a more generous offer than the previous proposal, when the bar for extra pay was set at one in three.
The offer also included increasing fines levied against trusts for over-working doctors, and increasing the extra pay medics get for very long hours.
The set of proposals was presented to the BMA on Tuesday evening, on the eve of the strike, and rejected on Wednesday afternoon when the walk-out was in full swing.
How will ministers impose a contract?
In theory, it’s pretty easy. Junior doctors rotate through jobs quickly so within six months of the new contract coming into force in August 80% of medics would be on it.
Between now and then hospitals will have to review their rotas and staffing requirements, before sending out offers to junior doctors in May.
But the big unknown is how the British Medical Association and medical workforce will react. Behind the scenes there has been talk of more strikes, mass resignations and non-signing of the contract.
Doctors have also warned of “brain-drain” with medics heading abroad, to other parts of the UK or into other sectors, such as the drugs industry. This, it seems, is unchartered territory – imposing a whole new contract on doctors is thought to have never been done before.
The offer was made by Sir David, the chief executive of Salford Royal Hospital, who was brought in by ministers last month to broker a deal in the bitter dispute.
Speaking to the BBC, Sir David said the “end of the road” had been reached with negotiations.
“We need to bring the matter to a close,” he added.
But in a letter to Sir David to reject the offer, the BMA stuck to its stance that any Saturday working should attract higher pay. It also reiterated its counter proposal made previously that basic pay be increased by only about half the 11% offered by ministers to help pay for it.
The government appears to be planning to impose the contracts from August. It is unclear at the moment how the BMA will respond to imposition, although their mandate allows them to call more strikes.
On Thursday the union said it would not be making a statement until the health secretary had addressed the House of Commons.
During the strike BMA junior doctor leader Dr Johann Malawana said the government had “attacked” and “patronised” the profession. There are 55,000 junior doctors in England – a third of the medical workforce.
Chris Ham, chief executive of the the King’s Fund think tank, said no government has ever previously imposed a contract on junior doctors, and to do so would be a “huge risk”.
“As long as that public support for junior doctors remains in place, the government has an uphill struggle to persuade the public it’s doing the right thing at the right time.
“Nobody argues against seven-day working. But there’s a really important discussion to be had about, will the junior doctors’ contract really help that – or are other things far more important? The government really is entering very dangerous territory.”
Source By: BBC