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, said the permanent shift will make greater use of other clinicians following a series of disruptive strikes by the medics.

He also warned the NHS risks a ‘long slog’ of walkouts lasting 12 months if the government fails to reach a pay deal with the British Medical Association imminently.

It comes as the union prepares to march resident doctors – previously known as junior doctors – out on strike for six days from Tuesday in pursuit of a 26 per cent pay rise.

The Government last night scrapped plans to expand speciality doctor training places after the BMA failed to meet its deadline 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.

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 overtime payments to senior colleagues and lost activity.

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 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’.

However, 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’, he added.

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

And he said 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 consultant members on their own strike action.

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

Sir Keir Starmer warned on Monday that he would axe the places if the union did not postpone the walkout within 48 hours and put a pay offer to members.

The prime minister accused the medics 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.

Sir Keir gave the BMA 48 hours to call off the strikes and said failing to do would lead to the Government withdrawing an offer to create at least 4,000 new specialty training posts in the NHS, for which resident doctors can apply after their first two years of training.

Speaking to LBC Radio today, Dr Jack Fletcher, chair of the British Medical Association’s resident doctors committee, said scrapping the extra training places is ‘bad for doctors, and it’s also bad for patients’.

He added: ‘The way out of this is to sit down and work together to get out of this.’

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.’