¹ Report of the Royal Commission on Doctors' and Dentists' Remuneration 1957–1960 (Pilkington Report), Cmnd 939, HMSO, London, 1960, pp. 8–9.Google Scholar

² The full HJSGC consisted of eight members elected by the representative body (training grades), thirty-six elected by regional (elected) HJSGSs in England, seven by the Scottish HJSGC, two each by Wales and Northern Ireland, six non-voting representatives from other BMA committees and, ex officio, the Scottish HJSGC chairman and a junior member of the BMA Council elected by the Junior Members' Forum. Up to three members could be co-opted – British Medical Journal, 28 December 1974, 786–7.Google Scholar

³ Review Body on Doctors' and Dentists' Remuneration (DDRB), Fifth Report, Cmnd 6032, HMSO, London, 1975, p. 37.Google Scholar

⁴ British Medical Journal, Supplement, 10 November 1973, 31.Google Scholar

⁵ Ibid. Recommendation 20, p. 33.

⁶ Ibid. pp. 36–7.

⁷ Pulse, 25 October 1975, 2.Google Scholar

⁸ British Medical Journal, 18 January 1975, 159–60.Google Scholar

⁹ See Gordon, H. L. and Iliffe, S. R., Pickets in White: The Junior Doctors' Dispute of 1975: A Study of the Medical Profession in Transition, MPU Pūblications, London, 1977, p. 40.Google Scholar

¹⁰ JHDA, Junior Hospital Doctors' Handbook, London, 1977, p. 53.Google Scholar

¹¹ The Times, 17 November 1975, 4.Google Scholar

¹² DDRB, Fifth Report, p. 37.Google Scholar

¹³ The Attack on Inflation, Cmnd 6156, HMSO, London, 1975.Google Scholar

¹⁴ See Gordon and Iliffe, op. cit. p. 45.

¹⁵ British Medical Journal, 1 March 1975, 534.Google Scholar

¹⁶ See Levitt, R., The Reorganised National Health Service, second edition, Croom Helm, London, 1977, p. 90.Google Scholar

¹⁷ DDRB, Supplement to Fifth Report, Cmnd 6243, HMSO, London, 1975.Google Scholar

¹⁸ Ibid. para. 7, pp. 3–4. In July 1975 the HJSGC had become the Hospital Junior Staffs Committee (HJSC).

¹⁹ Ibid. Table 4, pp. 24–5.

²⁰ Report of the Royal Commission on Medical Education (Todd Report), Cmnd 3569, HMSO, London, 1968, pp. 46 and 52.Google Scholar

²¹ In June 1975 a DHSS Health Service Circular (Interim Series), HSC (IS) 157, indicated that junior doctors could retain their existing contracts if they would lose money on the new contract. Subsequently the DHSS argued that ‘no detriment’ only applied to the previous basic salary, and not to the extra duty allowance contribution to income – British Medical Journal, 18 October 1975, 179.Google Scholar

²² DDRB, Supplement to Fifth Report, para. 19, p. 10.Google Scholar

²³ Pulse, 27 September 1975, 2.Google Scholar

²⁴ British Medical Journal, 18 October 1975, 178.Google Scholar The ‘principle’ motion was passed by forty-five votes to four. The ‘pricing’ motion was passed by forty-one votes to nine.

²⁵ See Gordon and Iliffe, op. cit. p. 50.

²⁶ Pulse, 15 November 1975, 2.Google Scholar

²⁷ Shattock, F., in British Medical Journal, 27 12 1975, 762.Google Scholar For example 51.7 per cent of those returning valid votes (14, 213), 61.2 per cent of those entitled to answer the question, and 58 per cent of those who actually answered the question favoured industrial action. The BMA claimed that the response rate was very high (90 per cent), as the electorate was ‘only 15,000 to 16,000 NHS contract holders’ – British Medical Journal, 22 November 1975, 425.Google Scholar But in 1975 there were 21,803 junior doctors in hospital practice – Doctor Manpower 1975–2000, Research Report no. 4, Royal Commission on the National Health Service, HMSO, London, 1978, p. 42.Google Scholar

²⁸ British Medical Journal, 6 December 1975, 598.Google Scholar

²⁹ See Gordon and Iliffe, op. cit. p. 59.

³⁰ British Medical Journal, 27 December 1975, 772–3.Google Scholar

³¹ It did not end immediately after the December meeting, as claimed by the authors, in Gordon and Iliffe, op. cit. p. 65.

³² DDRB, Third Supplement to Fifth Report, Cmnd 6406, HMSO, London, 1976.Google Scholar

³³ Pulse, 20 March 1976, 2.Google Scholar On average 93 per cent of all units of medical time over the standard week were being paid at the Class A rate. The review body later estimated an annual cost of £30.4 million for supplements, on the basis of claims under the new contract – DDRB, Seventh Report, Cmnd 6800, HMSO, London, 1977, para. 25, p. 15.Google Scholar

³⁴ DDRB, Sixth Report, Cmnd 6473, HMSO, London, 1976.Google Scholar

³⁵ One reason given for this was that consultants were resentful that juniors earning in excess of £8,500 were receiving the £312 increase while they themselves were excluded – Pulse, 10 July 1976, 2.Google Scholar Also all junior doctors had been given the right to practise privately outside their contract, whereas whole-time NHS consultants were barred from private practice. Moreover there was increasing financial disadvantage in the move from senior registrar to consultant, because of the new contract.

³⁶ DHSS, 76/209, 25 August 1976.Google Scholar

³⁷ British Medical Journal, 1 November 1975, 248.Google Scholar

³⁸ See Gordon and Iliffe, op. cit. p. 13.

³⁹ For example Dr Wasily Sakalo, an Australian registrar active in the north west of England who received much attention from the news media during the dispute, claimed that the relatively unfavourable financial position of English junior doctors compared with that of juniors in Australia was a personal motivating factor – The Times, 19 November 1975, 4.Google Scholar

⁴⁰ See Cuming, M. W., Personnel Management in the National Health Service, Heinemann, London, 1978, p. 184.Google Scholar

⁴¹ See for example Elliot, F. R., ‘Professional and Family Conflicts in Hospital Medicine’, Social Science and Medicine, 13 (1979), 57–64.Google Scholar

⁴² The problem centred around the unequal distribution of doctors between regions and specialities, and career opportunities, which change over time. Basically there was ‘inconsistency between the idealized versions of specialist training and the pattern of medical practice…established in NHS hospitals’ – Doctor Manpower 1975–2000, p. 42.Google Scholar

⁴³ In July 1976 some were ‘still asking what UMTs were’ – British Medical Journal, 24 July 1976, 255.Google Scholar There was also evidence that ‘lack of communication between the centre and the hospital messes was as much the cause of the row over the contract as was its contents…This microcosm of junior staff were obviously uncertain about what protest action to take or at whom to direct it…The back end of the BMJ was unmapped territory to them…’ – British Medical Journal, 18 October 1975, 157.Google Scholar

⁴⁴ See Gordon and Iliffe, op. cit. p. 40. The HJSC apparently had ‘great difficulty in getting the same faces together for successive meetings’, with inexperienced doctors deputizing for others – Pulse, 25 October 1975, 2.Google Scholar

⁴⁵ Pulse, 6 December 1975, 2.Google Scholar

⁴⁶ See for example The Times, 1 December 1975, 13Google Scholar; and 3 December 1975, 17.

⁴⁷ See for example The Times, 27 October 1975, 13.Google Scholar

⁴⁸ Cited in ordon and Iliffe, op. cit. pp. 54–5.

⁴⁹ One miners' union threatened that miners would not restrain their wage claims if the junior doctors were allowed to break pay policy – The Times, 28 November 1975, 6.Google Scholar

⁵⁰ See Gordon and Iliffe, op. cit. p. 54.

⁵¹ Pulse, 6 December 1975, 3.Google Scholar

⁵² Editorial in The Guardian, 25 October 1975.Google Scholar

⁵³ The Economist, 29 November 1975.Google Scholar

⁵⁴ Pulse, 27 November 1976, 4.Google Scholar The JHDA believed that ‘correctly manipulated [the contract] should bring between £1,500 and £3,500 to virtually every junior doctor's salary within this next year’ – On Call, 17 February 1976, 3.Google Scholar Mr Ennals said later that each junior was receiving an average £800 a year extra because of the new supplement system – The Times, 16 July 1976, 2.Google Scholar Between April 1975 and April 1976 juniors' earnings moved ahead by, on average, 5 per cent, relative to the earnings of those at comparable income levels – DDRB, Seventh Report, para. 27, p. 17.Google Scholar This was over and above the April 1975 increase.

⁵⁵ A report published in April 1976 by the Social Services and Employment Subcommittee of the Commons Expenditure Committee concluded that the main cause of the discrepancy between the DHSS and Price Waterhouse audit estimates of the available money was inefficient processing of claims. In addition accurate figures on the number of junior doctors and their hours of work had not been available, as BMA, JHDA and DHSS figures confused the issue – The Times, 28 April 1976, 2.Google Scholar

⁵⁶ DDRB, Sixth Report, para. 20:13Google Scholar. In 1978, however, the review body agreed to relate salary scales to the ten-units-of-medical-time week – DDRB, Eighth Report, Cmnd 7176, HMSO, London, 1978, para. 32, p. 21.Google Scholar

⁵⁷ See for example Pulse, 6 December 1975, 3.Google Scholar

⁵⁸ See Gordon and Iliffe, op. cit. p. 63. The authors' analysis portrayed greater unity (they were MPU members), and downplayed the conflict between the JHDA and the BMA. The JHDA itself blamed the government for exploiting lack of unity in the profession – On Call, 11 November 1975, 12.Google Scholar

⁵⁹ Important recommendations relating to expansion of the consultant grade and establishment of a new training grade (supported by the HJSC) were later opposed by the CCHMS because consultants did not want to lose the labour of their junior staff – British Medical Journal, 26 January 1980, 265.Google Scholar

⁶⁰ On Call, 28 October 1975, 8.Google Scholar

⁶¹ British Medical Journal, 12 June 1976, 1,480.Google Scholar

⁶² The HJSC structure was to be changed to resemble the GMSC and local medical committee structure, to facilitate better representation on the basis of the smaller NHS areas as opposed to regions – Pulse, 13 December 1975, 2.Google Scholar

⁶³ Pulse, 26 June 1976, 2.Google Scholar

⁶⁴ Pulse, 12 June 1976, 2.Google Scholar

⁶⁵ DHSS, Annual Report 1975, Cmnd 6565, HMSO, London, 1976, p. 27.Google Scholar

⁶⁶ On the State of the Public Health for the Year 1976, annual report ot the Chief Medical Officer of the DHSS, HMSO, London, 1977, p. 13.Google Scholar The ascribed reason was the occurrence of a major influenza epidemic rather than disruption in medical services.

⁶⁷ An inquest determined that the death of a five-month-old baby, Bhola, Seema, on 10 December 1975Google Scholar, after admission to two hospitals had been refused, had not been due to the industrial action.

⁶⁸ For example the JHDA had recommended that only terminations of pregnancy on medical indications should be performed – On Call, 9 December 1975, 9.Google Scholar While the DHSS received no formal complaints from patients – The Times, 3 December 1975, 2Google Scholar – the Patients' Association reported suffering and complaints – The Times, 19 November 1975, 4.Google Scholar

⁶⁹ See Illich, I., Limits to Medicine, Medical Nemesis: The Expropriation of Health, Pelican, Harmondsworth, 1976.Google Scholar

⁷⁰ Rogers, A., in Pulse, 27 November 1976, 4.Google Scholar

⁷¹ See Badgley, R. F. and Wolfe, S., Doctors' Strike: Medical Conflict in Saskatchewan, Atherton Press, New York, 1967, 73.Google Scholar

⁷² See Congalton, A. A., ‘Public Evaluation of Medical Care’, Medical Journal of Australia, 24 (1969)Google Scholar, 1,165.

⁷³ See Best, G., Dennis, J. and Draper, P., Health, the Mass Media and the National Health Service, Unit for the Study of Health Policy, London, 1977.Google Scholar

⁷⁴ Examples of publications are Badgley and Wolfe, op. cit.; Belmar, R. and Sidel, V. W., ‘An International Perspective on Strikes and Strike Threats by Physicians: The Case of Chile’, International Journal of Health Services, 5:1 (1975), 53–64CrossRefGoogle ScholarPubMed; Marcus, S. A., ‘The Purposes of Unionization in the Medical Profession: The Unionized Profession's Perspective in the United States’, International Journal of Health Services, 5:1 (1975), 37–42CrossRefGoogle ScholarPubMed; and Gordon and Iliffe, op. cit.

⁷⁵ See Smart, G. A., ‘The Provision of Medical Care in Hospital in the United Kingdom and its Effect on Medical Education’, in Kent, P. W. (ed.), International Aspects of the Provision of Medical Care, Oriel Press, Stocksfield, 1976, p. 15.Google Scholar

⁷⁶ See Abel-Smith, B., Value for Money in Health Services, Heinemann, London, 1976, p. 5.Google Scholar

⁷⁷ Junior hospital posts meet service rather than training needs – Report of the Royal Commission on Medical Education, p. 46.Google Scholar The original HJSGC document on the contract had stated that training was not the main justification for hospital junior staff pay – British Medical Journal, Supplement, 10 November 1973, 31.Google Scholar

⁷⁸ See Wootton, B., ‘Towards a Rational Pay Policy’, New Society, 47:860 (1979), 736Google Scholar; and Navarro, V., Class Struggle, the State and Medicine, Martin Robertson, London, 1978, p. 127.Google Scholar

⁷⁹ See Werther, W. B. and Lockhart, C. A., Labor Relations in the Health Professions, Little, Brown and Company, Boston, 1976, p. 107Google Scholar; and ‘The Art of Negotiation’, editorial, New Society, 47:860 (1979), 723.Google Scholar

⁸⁰ In June 1978 the HJSC and the JHDA decided to withdraw from the review body system, but the decision was criticized by BMA consultants and general practitioners. In November 1978 the HJSC offered to abandon the right to take industrial action if junior doctors were given the right of direct bargaining on pay – The Times, 23 November 1978, 2.Google Scholar

⁸¹ Report of the Royal Commission on Doctors' and Dentists' Remuneration 1957–1960, paras 402–5, p. 140.Google Scholar

⁸² See Making Whitley Work, HMSO, London, 1976.Google Scholar

⁸³ See Hobsbawm, E. J., ‘Inside every Worker there is a Syndicalist Trying to Get Out’, New Society, 48:861 (1979), 8–10.Google Scholar