Junior doctors’ strike: Health secretary urges BMA to “show it is serious” about pay deal

Derogation dispute

The latest round of action saw disagreement between the BMA and NHS England over the 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, known as a derogation, was agreed between the BMA and NHS England when the dispute first began last year. The BMA said the process had worked well in all previous rounds of strike action. But 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, the association 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.”3

On 4 January NHS England wrote to the BMA to respond to the concerns raised. It said it was “regrettable” that the BMA had questioned “the integrity and motive of local clinical leaders—some of whom are likely to be BMA members—who are requesting patient safety mitigations on behalf of their services, the staff who are working within them, and the patients who need them.”4

NHS England said that the BMA had received more requests for junior doctors to be recalled than in previous rounds of action because of the time of year and the length of the action, “as well as the fact that the impact of industrial action on NHS services and patients has continued to grow with each action (including those called by other unions).”

In its letter NHS England said that it would make changes to how it dealt with the derogation process. This included following up with trusts that had derogation requests either rejected by the BMA or not considered in a timely fashion, “to compile a picture of the impact this has had on services.”

NHS England will also “reinforce the extant requirement for providers to record any patient safety incidents, and to specifically report those which occur during periods of industrial action to regional teams, so that we can evidence harm and near misses which might have been avoided.” It asked the BMA to consider allowing local medical leaders the opportunity to put their case directly to the committee when their application for a patient safety mitigation was being considered. A BMA spokesperson said the association was considering NHS England’s letter.

The BMA granted a derogation for one junior doctor to work on the neonatal unit at University Hospital Lewisham for the day shift on 5 January. “The trust have informed us that alternative sources of staffing have been exhausted,” the BMA said.

The union also granted a derogation for one junior doctor to work the night shift at the obstetric unit at Nottingham University Hospitals NHS Trust on 5 January because of an unexpected, last minute event.5 “Our priority is patient safety,” the BMA said.

In her weekly message to NHS leaders sent on 5 January, Pritchard thanked junior doctors who “returned to work to ensure minimum levels of cover” during the latest action, “whether or not formal patient safety mitigations were granted” by the BMA.

Polling by YouGov, shared with the Times newspaper, suggested that public support for striking junior doctors was waning, although the proportion of those surveyed who supported the latest strike (45%) was still higher than the 42% who were opposed.6