A row has broken out between the British Medical Association and NHS Employers over a perceived threat to stage a total walkout of consultants and junior doctors at trusts which do not cancel all but agreed elective activity during next week’s three-day strike.
The union has asked trusts to confirm that no elective activity, other than that agreed through derogations, will be going ahead during next week’s unprecedented joint action by junior doctors and consultants.
If this confirmation is not forthcoming, trusts are concerned the union will not authorise ”Christmas Day” cover, during which minimal emergency services would remain open, and instead require all members to strike.
However, the BMA has denied that this is the case.
A BMA letter sent to trusts on Thursday, and seen by HSJ stated: ”As you will already be aware, the BMA’s legal strike mandate allows for all eligible consultant and ‘junior’ doctors to undertake a full walk out on strike days and the concept of ‘Christmas day cover’ or “lowest safe staffing level” for joint strike days is, in effect, a nationwide exemption to that right granted voluntarily by the BMA.”
It continues: “Our position regarding Christmas day cover is based on there being no elective activity beyond any agreed via the established national derogation process as set out in the joint letter from NHSE and the BMA on 12th July 2023. I am therefore writing to ask you to confirm formally whether you have cancelled all elective care for each of the three strike days next week (Monday 2nd, Tuesday 3rd and Wednesday 4th October 2023) so that your position may be considered by the BMA.”
In an email to NHS leaders today, NHS Employers chief executive Danny Mortimer said the inference of the letter was that ”unless employers confirm the cancellation of electives, Christmas Day cover would be withdrawn in favour of full walkout.”
The NHS Employers chief executive also revealed that he has written to BMA council chair Professor Philip Banfield to raise his concerns.
In this letter, also seen by HSJ, Mr Mortimer writes: ”I am disappointed that to my knowledge, you have not shared this letter or approach with myself, my team at NHS Employers or national colleagues at NHS England.”
He states that, “with industrial action now just a weekend away this potential risk to the careful planning of patient care is alarming for my employer colleagues.”
Mr Mortimer writes: ”Yesterday’s letter refers to the BMA/NHS England letter of 12 July 2023. The contents of that letter were jointly agreed by BMA and NHS England colleagues prior to publication. It outlines how Christmas Day cover is defined, shares the BMA advice that elective care is not scheduled but goes on to state that trusts should work on the basis of staff taking strike action would not support scheduled activity. It further agrees the importance of P1, P2 elective surgery and cancer care.”
He continues: ”It does not state in the joint letter that Christmas Day cover is dependent on the cancellation of electives. Any implication that minimal cover of, for example, an emergency department, is dependent on, for instance, ophthalmology electives being cancelled does not seem tenable. How employers plan their patient care during periods of industrial action is a matter for local determination, with careful planning and engagement with local negotiating committees. I would therefore advise employers colleagues who have received your most recent letter they are not required to provide to you the requested information on elective services during industrial action.”
However, a BMA spokeperson told HSJ: ”Mr Mortimer has clearly misunderstood the situation. It is categorically untrue to say that the BMA will remove Christmas Day cover in favour of a full walkout during the joint action by consultants and junior doctors next week.
“The BMA has always maintained that we would ensure emergency services for patients remain in place during periods of industrial action, but that no elective activity should be scheduled. This is because we are concerned that patient safety may be put at risk if patients undergoing elective procedures suffer complications as support services are only staffed to Christmas Day levels of cover.
“This is entirely consistent with the process agreed with NHS England and communicated in the joint letter.”
Speaking after the BMA’s confirmation of its stance Mr Mortimer said: “Health leaders are grateful the BMA has cleared up the confusing communications in its letter to NHS trusts. and that it has confirmed resolutely that “Christmas Day cover” during next week’s planned strikes should under, no circumstance, be dependent on the cancellation of electives.”
Trusts are working towards a national target to eliminate all 65-week waits for elective care by March next year against a backdrop of industrial action. Around 60,000 inpatient appointments and more than half a million outpatient appointments were postponed during the junior doctor strikes between March to July, according to NHS England data. This does not take into account activity lost due to the strikes, nor the disruption before and after the strike days.