NHS England and trusts are undermining process for recalling striking doctors, says BMA – GWC Mag

NHS England and some NHS trusts are undermining the process for recalling striking junior doctors in unexpected and extreme circumstances, placing the BMA in an “impossible situation,” the union has said.

Junior doctors in England began a six day strike—the longest single walkout in NHS history—at 7 am on Wednesday 3 January.1

When the dispute between the government and junior doctors began last year, the BMA said it had agreed with NHS England a voluntary process for recalling striking junior doctors to work in the event of safety concerns arising from “unexpected and extreme circumstances” unrelated to industrial action. This process is called a derogation.

The BMA said the process had worked well in all previous rounds of strike action. However, during the current round of industrial action NHS England and some trusts had requested derogations without providing the BMA with the information it needed to recall striking doctors, it said.

In a letter sent to Amanda Pritchard, chief executive of NHS England, on 3 January the BMA’s chair of council, Phillip Banfield, said that NHS England and some trusts had refused to give evidence of any efforts to source alternative staffing or demonstrate rearrangements or cancellation of less urgent work.

“This refusal to provide the information necessary to take well informed decisions is fundamentally undermining the derogation process, as we are being asked to take decisions about our members’ right to strike without the requisite information,” Banfield wrote. “NHS England, it feels, is wilfully placing the BMA in an impossible situation.”

The BMA said it had received derogation requests containing incomplete and inaccurate information, such as an unevidenced assertion that no additional consultants or SAS (specialist, associate specialist, and specialty) doctors were available to provide cover for junior doctors.

In his letter to Pritchard, Banfield wrote that some of the union’s local negotiating committee leaders had told the BMA that their employers had decided to apply for a derogation in advance of strike action and before alternative solutions could be pursued.

In addition, Banfield said, consultants on the front line of care in several of the departments the BMA had received requests from had expressed surprise that a derogation request had been submitted, telling the union the departments were staffed safely.

“We are increasingly drawing the conclusion that NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action, and push the BMA into refusing an increasing number of requests; requests, we believe, would not have been put to us during previous rounds of strike action,” Banfield wrote. “The change in approach also appears to be politicisation and weaponisation of a safety critical process to justify the Minimum Service Level regulations.”

The letter called on Pritchard to intervene urgently to make sure that the derogations process was used as intended: as a last resort when alternative staffing schemes had failed to provide cover for urgent, emergency, and critical care.

Commenting on the letter, Matthew Taylor, chief executive of the NHS Confederation, said the strikes had come during one of the busiest weeks of the year for the health service, with trusts facing rising levels of winter viruses and higher than anticipated staff sickness.

“A number of trusts have already declared critical incidents, with pressure likely to get worse as the walkout continues this week,” he said. “Rather than accusing hospital leaders of refusing to provide the required information in full to the BMA, this is more about them needing to limit the precious time they and their teams have available to fill in forms when patient safety could be at risk.”

Taylor said the confederation had called for national derogations to be agreed in advance of strike action, as not all NHS organisations had a wide range of alternative staffing arrangements at their fingertips. “In the absence of these, we hope the BMA will cooperate with time critical requests from NHS trusts and that the recall process runs smoothly in the best interest of patients.”

An NHS spokesperson said the NHS had a robust process in place for seeking derogations from the BMA to prioritise patients’ safety and this involved providing strong evidence where the most challenged systems needed support. “Given that this period of industrial action coincides with the most difficult time of year for the NHS, it is to be expected that more senior medical leaders will ask their colleagues for allowances to be made to ensure safe levels of cover,” the spokesperson said.