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Staff face one of the “toughest” winters ever (doi:10.1136/bmj.r2620), says the chief executive of the NHS.1 The annual flu season arrived early, and vaccination rates are low among the public and staff. The flu season is now as inevitable as the season of discontent in the medical profession. Resident doctors are in dispute with the UK government, primarily over pay restoration but also over working conditions and specialty training posts (doi:10.1136/bmj.r2614).2 General practitioners are fuming over their new contract and the absence of any clear thinking in the NHS 10 year plan about how general practice will integrate with the new neighbourhood health hubs (doi:10.1136/bmj.r2526).3