Health Secretary Jeremy Hunt has been urged to conduct an urgent independent review into the welfare and morale of trainee doctors.
The recommendation was made by Sir David Dalton - the government's chief negotiator in talks over proposed new junior doctors' contracts - in a letter which also recommended ending efforts to negotiate a deal.
He said that both sides in discussions over contracts had acknowledged acknowledged that there are "underlying issues which, over a number of years, have created the conditions for doctors in training to feel a high level of discontent".
"I wish to confirm my recommendation to you that an urgent Review of these long standing concerns should be established which can make meaningful recommendations to improve the welfare and morale of trainees," he added.
The letter said the review should be commissioned by the Academy of Medical Royal Colleges, Health Education England and NHS Employers, and should "ensure that the voices of junior doctors are directly and personally heard".
The government's chief negotiator in talks over junior doctors' proposed new contracts has written to health secretary Jeremy Hunt to tell him a deal is "not possible".
Sir David Dalton has told the health secretary to "do what he deems necessary" to put the contract in place after a row that has so far prompted two 24-hour strikes.
The letter could pave the way for Mr Hunt to impose the contracts without reaching an agreement over the remaining dispute - government plans to class Saturdays as normal working days.
In the letter, Sir David - who is also chief executive of Salford Royal NHS Foundation Trust - said: "Everyone’s first preference has always been for a negotiated outcome. Unfortunately this no longer seems possible.
"Following consultation with Chief Executives and other leaders in the service, it is clear that the NHS needs certainty on this contract and that a continuation of a dispute, with a stalemate and without any clear ending, would be harmful to service continuity, with adverse consequences to patients," he continued.
"On this basis I therefore advise the government to do whatever it deems necessary to end uncertainty for the service and to make sure that a new contract is in place which is as close as possible to the final position put forward to the BMA yesterday."
Junior doctors have returned to work after a 24-hour walkout over proposed new contracts.
The deadlock has shown little sign of breaking - with the major sticking pointing remaining over weekend pay and whether Saturday should be classed as a normal working day.
Around 1,140 planned inpatient procedures were cancelled as a result of the latest walkout, alongside 1,734 day procedures, according to analysis by NHS England.
NHS England confirmed that 43% of junior doctors reported for duty on the day shift - a figure including doctors who had never intended to strike, such as those working in emergency care.
New contracts could be imposed on junior doctors by the Health Secretary after union leaders rejected his "best and final offer".
The Government's chief negotiator, Sir David Dalton, had warned talks were at "the end of the road" should the British Medical Association not endorse his latest offer by Wednesday afternoon.
Instead the BMA again called on the Health Secretary to accept its own proposed pay model and withdraw his threat to force through changes, even though the Government has refused to "remove that from the table".
A 24-hour strike by medics will end at 8am today.
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Junior doctors from across the region are striking for a second time today in a dispute over changes to their contracts and seven-day working.
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The Calder Valley MP Craig Whittaker is leading calls for flood-hit businesses to be given help to insure their properties.
Craig Whittaker spoke in a debate in Parliament last night about the difficulties businesses are facing. Simon Waring is himself an insurance broker but can't now get cover. Mr Whittaker said it's a wider problem affecting many in the area: