NHS to overhaul staffing to be less dependent on ‘unreliable’ doctors

The NHS will overhaul frontline staffing so it becomes less dependent on ‘unreliable’ resident doctors, its chief executive has said.

Sir Jim Mackey, head of NHS England, warned the service faces a ‘long slog’ of walkouts lasting another 12 months if the government fails to reach a pay deal imminently.

The permanent shift in how the NHS deploys its workforce is likely to see it make greater use of other clinicians, such as nurses, pharmacists and paramedics.

It follows a series of disruptive strikes by members of the British Medical Association and comes as it prepares to march resident doctors out on strike for six days from Tuesday in pursuit of a 26 per cent pay rise.

The medics – previously known as junior doctors – currently have a six month strike mandate, which runs until August.

But newly implemented laws championed by former Labour deputy leader Angela Rayner mean any future ballot would give the union a mandate for a full year.

Next week’s walkout will be the 15th round of strikes by resident doctors in England since 2023 and is expected to cost the NHS more than £250million in lost activity and overtime payments to senior colleagues.

Sir Jim told the Health Service Journal that NHS England is asking: ‘How do you build [services] less reliant on a transient training workforce and more on a more blended clinical family?’

He said it is necessary to explore alternative service models ‘if we continue to have a system that feels unreliable, [when] one of the key things the population needs from us is reliability’.

And he indicated the organisation would get ‘more active in this area’ if it faced a ‘long period of strikes’ but stressed this was not meant ‘as a threat to residents’.

The NHS England chief said some local leaders had told him services ran more smoothly during resident doctors’ strikes, when consultants and other clinicians had filled in for them.

And alternative ways of working that make less use of resident doctors would also better suit hospitals that had long struggled to recruit trainees.

Sir Jim previously built a less resident doctor-reliant service at Northumbria Healthcare Foundation Trust, which he led for 20 years up to 2023.

He acknowledged that ‘a pipeline of consultants’ is needed but argued there are ‘different service models that are less reliant [on trainees]’ successfully operating in other countries.

He was speaking on Tuesday before news broke that the BMA will also ballot senior doctors, including consultants, on their own strike action.

Sir Keir Starmer has accused resident doctors of ‘recklessly’ walking away from an offer that would have seen some earn more than £100,000 a year.

Last week the BMA’s resident doctors’ committee rejected an offer worth up to 7.1 per cent for this year without even putting it to members for a vote.

The proposed deal would have taken their total pay rise over the past three years to 35 per cent.

The ‘hypocritical’ union has said that inflation caused by the Iran war means they need a bigger rise despite offering its own staff an uplift of just 2.75 per cent.

Health secretary Wes Streeting today wrote to Dr Jack Fletcher, chair of the BMA’s resident doctors committee, describing the latest round of strikes as ‘unnecessary and damaging’.

He added: ‘Having rejected the deal that we had agreed with you and your officers, I had expected the BMA Resident Doctors Committee to at least come back with a counterproposal to end these strikes, given your stated commitment to reaching a negotiated settlement.

‘You could not agree one.

‘If members of your committee cannot reach an agreed position among themselves, it is hard to see how the Government will be able to reach an agreement with your committee.’

The Government scrapped plans to expand speciality doctor training places yesterday after the union failed to meet a 48 hour deadline set by the prime minister to call off the industrial action.

The move would have allowed more resident doctors to advance their careers by undertaking additional training to become specialists.

But the Department of Health and Social Care said it would no longer be ‘financially or operationally’ possible to offer 1,000 more places this year as the NHS prepares to deal with the fallout from the strike.

Resident doctors today said they would ‘happily’ meet with Mr Streeting over the long Easter weekend in bid to avoid next week’s walkouts, but said there must be ‘an improvement’ on the deal.

Mr Streeting said the pay offer meant that ‘for the most experienced resident doctors, basic pay would have increased to £77,348 and average earnings would have exceeded £100,000’.

First-year doctors fresh out of medical school would earn on average £52,000 a year, £12,000 more than three years ago.

This is more than many NHS staff in other roles will earn at the peak of their career.

Sir Keir said the offer was made after ‘months of collaboration with the BMA’ and their refusal to now accept will leave patients ‘paying the price’.

He added: ‘That is why walking away from this deal is the wrong decision. It is reckless.’