An overwhelming majority of 98% of junior doctors are in favour of going on strike in a dispute with ministers over a new contract. Almost 40,000 medics were balloted by the British Medical Association (BMA) on industrial action, amid protests to changes to their contract proposed by the Health Secretary, Jeremy Hunt. This will be the first “all out” strike in the history of the NHS. 

The vote in favour came despite fears that the plans, coming at the height of the winter, could endanger lives. Professor Sir Bruce Keogh, national medical director of NHS England, suggested that the BMA could rue its decision should there be a terrorist attack. 

In a letter to the BMA, he wrote: "In light of the tragic events in Paris last Friday night, and the ongoing threat level in the UK, we need to ensure we have a clear understanding of arrangements should a major incident be declared. 

"Will junior doctors, who would otherwise have been rostered for duty make themselves available to respond in a timely way, within one hour of a major incident being declared?" 

The first walk-out will start on 1 December with another two days earmarked for later in the month. Junior doctors will still staff emergency care on the first day. On the other two dates, they will walk out leaving other medics such as consultants, staff doctors and locums to fill the gaps. 

The action is likely to lead to the cancelling and rescheduling of thousands of routine appointments, tests and operations with the NHS forced to prioritise emergency cases. 

The BMA said it was “inevitable” that disruption would be caused to patients as a result of the strikes but maintained it had been left with no choice as the contract proposed by Mr Hunt was “unsafe”. 

Mr Hunt said: "It is regrettable that junior doctors have voted for industrial action, which will put patients at risk and see operations cancelled or delayed. "We want to ensure that patients have the same quality of care across the week, and have put forward a generous offer that increases basic pay by 11% and reduces doctors' hours. We hope that junior doctors will consider the impact of this action - especially the withdrawal of emergency care - will have on patients and reconsider." 

Mr Hunt warned that it would be “very difficult” to avoid patients coming to harm if a series of strikes went ahead. Changes to junior doctors were proposed by Government as part of efforts to improve patient safety and increase levels of cover at weekends. 

The BMA says the terms would cut overall pay and damage safety by removing penalties for hospitals if doctors work excess hours. 

Ahead of the ballot, the Health Secretary offered new assurances, promising that three quarters of juniors would see an increase in pay, with pay protected for all but one per cent of doctors until 2019. He also promised new rules to limit overall hours far more than the current maximum. 

Scotland and Wales have said they do not want to introduce the contract changes, while Northern Ireland has yet to make a decision. 

Rebecca Morgan, clinical negligence associate, explains: “It is devastating that junior doctors feel that they have no alternative but to strike in response to Mr Hunt’s proposals. Patients will be, at the very least, inconvenienced and we can only hope it does not lead to anything worse. I am hopeful that negotiations can be restarted with the doctors’ union in a bid to prevent the strikes by the NHS and breach the differences between the two sides, with the aim of achieving a safer and more reliable NHS.”