The number of appointments and operations cancelled due to junior doctor strikes is this week set to top a million, during an unprecedented six-day walkout.
More than 200,000 cancellations are expected, prompting warnings that the action is making it harder to bring down waiting lists and is putting people off seeking care.
NHS leaders have also said that in order to keep patients safe it is vital the British Medical Association (BMA) responds swiftly to any requests for doctors to leave pickets and return to work in the event that services come under too much pressure.
A total walkout beginning on Wednesday will involve thousands of BMA members, plus medics from the smaller Hospital Consultants and Specialists Association, downing tools until next Tuesday.
There have been 28 days of industrial action by junior doctors so far during the pay dispute, with a total of more than 940,000 cancellations in hospitals — an average of almost 34,000 per day. Hospital leaders say the true number of patients affected could be far higher, as they now avoid even scheduling clinics to begin on expected strike dates.
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Paul Farmer, chief executive at Age UK, said the timing and duration of this week’s strikes were “alarming”, with the risk to patients increasing as the dispute wore on. He said: “We know this is one of the busiest times of the year in the NHS, particularly for urgent and emergency care. We are deeply concerned about the risk this poses to older people’s health as, with the very best will in the world and efforts of staff, it will be difficult to guarantee safe and effective care for everyone who needs it.”
Farmer said the charity was very concerned at the prospect of older people feeling unwell being put off seeking care due to the strikes. The NHS has stressed that people should use NHS 111 and other services as normal if needed.
Farmer said: “We have increasingly heard from older people already struggling to access the help they need now worried what ongoing strikes mean for themselves, and their families on top. We know exactly how much older people value the care and support they receive from their doctors, but after nine months of industrial action we believe the current situation is simply unsustainable. We urge the government and the unions to get back round the table.”
Professor Yvonne Doyle, former medical director at Public Health England, told Times Radio that people could help themselves to stay out of hospital by taking steps including getting vaccinated and staying away from others if they had an infection. She added: “The other factor at this time of the year is cold weather — so older people, and people who are vulnerable to stroke, (should try to) to keep warm.”
The BMA is seeking “pay restoration” for junior doctors to 2008 levels, which it calculates as equivalent to a 35 per cent pay rise. Talks broke down after ministers offered only a 3 per cent bump to an average 8.8 per cent increase, already in place, before a deadline set by the union last month.
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Consultants and specialty and associate specialist (SAS) doctors have reached a deal with the government, which is now being voted on by union members.
On Tuesday Downing Street insisted the government was willing to have further discussions with the juniors. The prime minister’s official spokesman said: “We have sought to come to a fair resolution — fair for the taxpayer, fair for hard-working doctors and health workers. We have achieved that in the majority of cases.
“As the health and social care secretary [Victoria Atkins] made clear, we are willing to have further discussions, but obviously the first thing to do is to stop striking.”
The spokesman added that the strike, the longest in the 75-year history of the health service, was expected to have a “significant impact” during “an extremely busy and challenging time for the NHS every year”. “With so many operations having to be rescheduled as a result of strike action, we know that is having an effect on our ability to tackle that backlog,” he said.
The BMA has not agreed any national exemptions to strike action, despite requests from the NHS to keep doctors working in areas such as fast-progressing cancers, corneal transplant eye surgeries and births by time-critical caesarean sections. Instead, trusts can request that doctors return to work if there are “unpredictable events, major incidents [or] unexpected and extreme circumstances”.
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Danny Mortimer, deputy chief executive of the NHS Confederation, said: “With the next round of junior doctors strikes coinciding with what is always an exceptionally busy week for the NHS, health leaders hope that escalation plans run smoothly and with a shared understanding that protecting patient safety is the most important priority.”
He said that in the absence of key services being exempted nationally, “if local organisations feel the strikes are directly and significantly compromising patient safety, they need assurances this will be understood and acted upon swiftly by the BMA in allowing the striking doctors to temporarily return to work”.
The union has made it clear that it does not consider winter pressures alone to be sufficient to recall doctors to hospital work. Dr Robert Laurenson and Dr Vivek Trivedi, co-chairmen of the BMA’s junior doctors committee, said: “Patient safety is our top priority at all times, including during strike action, which is why we not only give trusts adequate notice to arrange appropriate cover but also have an established process with NHS England, which we have successfully used over the previous eight rounds of strike action, to constantly review staffing levels and act appropriately, including derogating staff back to work when absolutely necessary.
“Of course, these strikes don’t have to happen. We’ve been clear that it is the government that cancelled talks and we would still at this late hour encourage government to put forward a credible offer so that we can stop this strike and get back to doing what we really want to do: care for patients.”
How doctors’ pay stacks up
A doctor fresh out of medical school will receive a basic salary of £32,397 in their first year of practice, and £37,303 in their second.
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Their actual earnings will probably be higher than that, with additional payments built into contracts if, for example, their rota has a higher rate of unsocial hours or they work in London. For first year doctors the estimated average earnings are £41,300, and for second years £48,800.
After that point, those in core training have a basic salary of £43,922 and estimated average earnings of £62,300, according to analysis of NHS data by the Nuffield Trust think tank.
Specialty registrars — those on the cusp of becoming consultants — have a basic salary of between £55,328 and £63,162, with estimated average earnings of £71,300.
Doctors in training who are also members of the NHS Pension Scheme receive a pension contribution worth 20 per cent of their salary — although as it operates a defined benefit scheme this does not have a bearing on the actual pension value. They contribute up to 12.5 per cent from their pay packets to the scheme, depending on salary.
When compared with the salaries of other professionals, after the first year, all doctors earn above the national mean wage and most junior doctors are above the 80th percentile.
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Once a fully qualified consultant or GP, doctors can expect pay that is higher again. The basic salary of a consultant varies from £93,666 to £126,281. For a salaried GP it is £68,974 to £104,086. A GP partner’s estimated average earnings in 2020/21 were £163,900.
There is little information on doctors’ earnings from private practice. What there is suggests wide variation by specialism. Older research suggests it can account for nearly a third of consultants’ total earnings.
