Hospital bosses have been told to crack down on doctors’ ability to secure profitable locum shifts while out on strike.
Head of the NHS Sir Jim Mackey said previous industrial action had been ‘net positive from a financial point of view’ for medics and their walkout must not be ‘consequence-free’ this time.
Resident doctors – previously known as junior doctors – have taken industrial action 11 times since March 2023, leading to the cancellation or postponement of more than 500,000 appointments. This helped secure them a pay rise worth a total of 28.9 per cent over three years plus lucrative overtime payments as they made up the lost consultations they caused – which they effectively used to fund further walkouts.
Some doctors even worked shifts at other trusts at inflated rates while striking at their own employer. They are legally allowed to do so, as long as they do not work the hours they were scheduled to carry out during the strike.
Sir Jim, chief executive of NHS England, told hospital bosses in a call on Wednesday that he wants them to take a harder line against the British Medical Association and press ahead with as many routine operations as possible, even if it means fewer staff and bigger queues in A&E.
He said: ‘We’ve been very, very clear we want to have a different approach this time. You have noticed already we are in a different space compared to where we were last time, much more instructive to the BMA, much more resistant to their demands.
‘Frankly, we and you make decisions about safety, not the BMA. Do what you do best, make sensible decisions and we’ll stick together.’
Sir Jim also encouraged leaders to seek ‘derogations’, where resident doctors are required to work during the strikes, in more circumstances, the Health Service Journal reported.
Health Secretary Wes Streeting told hospital leaders ‘we have your backs’ if they choose to spread staff more thinly to ensure as many clinics as possible can go ahead.
‘We do have to think about harm in the broadest sense, and not the conventional ways which we’ve thought about urgent and emergency care,’ he added.
Professor Tim Briggs, the NHS England national director for clinical improvement and elective recovery, has criticised the strike by resident doctors. He said on BBC Radio 4’s Today programme: ‘As doctors, we are slightly different from other groups in that, yes, we have the right to strike, but we also have to make sure that we put the patient right at the centre of absolutely everything we do, and we must never harm patients.
‘This strike will harm patients, and for me, that is not acceptable. When I speak to resident doctors, it’s not about the core pay.’
He said the doctors were more concerned about their rotas, training bottlenecks ‘how they fund their courses, how they fund their exams and medical equipment.
‘And there has been a commitment by the Secretary of State and the Government to look at that in a very sympathetic way because they believe they can help that and smooth that pathway. So I can’t understand how we are in this position from the BMA.’
During the strike, GP surgeries will open as usual and urgent care and A&E will continue to be available for those who need them, NHS England said.
It urged the public to use 111 online as the first port of call.
Professor Meghana Pandit, NHS England national medical director, said: ‘There is no doubt this industrial action will take a toll on patients and NHS staff.
‘While it will mean some appointments won’t be able to go ahead as planned, we are doing all we can to limit this.
The BMA has criticised NHS England’s change in approach. Dr Tom Dolphin, chairman of the union’s governing council, said: ‘It’s worrying that NHS England appears intent on telling hospitals to continue providing non-urgent planned care on strike days, despite our warnings that this will leave staffing levels unsafe across the board.’
The BMA leaders at the heart of the walkout…
Radical who refused to talk to public
When Dr Ross Nieuwoudt appeared as a guest on Jeremy Vine’s Channel 5 magazine show earlier this month, the 29-year-old had the opportunity to explain to the public why he believed strikes were necessary. But the co-chairman of the BMA’s resident doctors committee refused to take calls from viewers on the advice of his ‘media team’.
Dr Nieuwoudt grew up in Truro, Cornwall. His doctor father, Francois, who emigrated from South Africa to the UK as a medical student, and mother, Beatrice, who is also South African, were formerly behind a ‘health and beauty salon’ where Francois administered acupuncture and ‘Chinese medicine’.
A former student council leader who graduated from the University of Exeter and became a doctor in 2021, he took on a role with the BMA in 2022.
He now works in emergency surgery at Aintree hospital in Liverpool where he lives in a three-bed apartment.
He has told doctors they do not have to tell their trusts they are planning to strike – sparking fears for patient safety – and earlier this year told the BMA’s annual representative meeting in Liverpool doctors were ‘excited’ for industrial action.
He later corrected this to ‘energised.’
Threats to cripple NHS with action
Dr Melissa-Sue Ryan, 45, has previously suggested collective action which would cripple the NHS is ‘on the horizon’.
She said resident doctors could co-ordinate strike action with consultants and specialist doctors embroiled in pay disputes, which was previously ‘immensely disruptive’ to patients.
In an interview with The Sunday Times in May, she added: ‘We have three grades of doctors that are in pay disputes and there could be terrible disruption if the government doesn’t intervene soon.’
Originally from New Zealand, Dr Ryan, who has a PhD in psychology and worked as a psychologist before studying medicine in Pavia, Italy, is now a paediatrician in Nottingham.
Together with Dr Nieuwoudt, she is a member of Doctors Vote, a campaign group committed to ‘full pay restoration’. They have a crab as their symbol, and use the slogan ‘be a crab, not a scab’.
Dr Ryan has regularly been seen on picket lines during previous strikes, and organised coaches to take doctors to rallies at Trafalgar Square.
In a post on X in 2022, she acknowledged there were ‘all-time highs in patient wait times and delays for care’ with the system ‘currently putting patient care at risk’.
