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Exclusive: 800 consultants refuse to cover juniors strike without extra pay

Published on: 7 Jun 2023

More than 800 medical consultants in London have signed a letter saying they will not cover the junior doctors’ strike next week unless their trusts agree to pay a higher overtime rate set by the British Medical Association.

The letter, sent to trusts in recent days and seen by HSJ, accuses the NHS in London of failing to act consistently with trusts outside the capital. It names several in other regions which, according to the authors of the letter, have agreed to pay higher rates.

A trust-by-trust count of how many consultants have signed the letter, created by NHS England’s regional office based on information from the doctors, shows wide variation in the proportion who have supported it.

It appears to have been coordinated by senior doctors independently of the British Medical Association, although the union said the move ”emphasises the strength of feeling among the profession”.

Nearly a quarter of the Royal National Orthopaedic Hospital Trust’s 112 consultants had signed the letter as of Tuesday. This compares with only 22 of the 1,291 consultants at Guy’s and St Thomas’ Foundation Trust.

The data seen by HSJ showed 8.7 per cent of the 9,153 consultants at London trusts had signed, although it excluded Great Ormond Street Hospital for Children or Moorfields Eye Hospital FT.

The letter sent to trusts by the doctors on Monday said: “NHS London’s failure to engage in negotiation of these terms for consultant/SAS doctors non-contractual work during the JD industrial action and capping of pay rates below the BMA rate card has not been in line with trusts and regions outside London.”

It added: “Why has NHS London and London trusts’ approach to patient safety and delivery of care deviated from these regions?”

The letter named Manchester University Foundation Trust, Princess Alexandra Hospital Trust in Essex, Leeds Teaching Hospitals, Alder Hey, East and North Hertfordshire, East Cheshire, and hospitals in Brighton, Hull and Blackburn among those which had agreed to pay the rate. None of the trusts commented on the issue when asked by HSJ.

It follows months of dispute over attempts by consultants and the BMA to drive up rates for additional consultant hours by encouraging doctors to ask to be paid according to the ratecards, amid high demand for extra sessions to tackle waiting list backlogs.

Some trust leaders are concerned that agreeing to the rates during junior doctor strikes — when a lot of extra cover is required from consultants and other clinicians in order to safely run emergency services — may set a precedent.

Commenting on the letter, a spokesperson for NHSE London said: “Our NHS hospital chief executives have already agreed a set of enhanced bank rates for consultants in London, for the periods of industrial action by junior doctors, to ensure our critical services are staffed safely and appropriately for the period of action. We’re extremely grateful for the continued hard work of all our NHS colleagues in the capital during this pressured time.”

The junior doctor strike is due to take place between 7am on Wednesday 14 June and 7am Saturday 17 June.

The BMA said it was not ”a BMA letter, but one drawn up by grassroots members”.

A spokesperson added: “The BMA’s rate card has been developed to address the fact that for too long trusts have been continually leaning on consultants to work many extra hours in excess of their normal contracts, not just during strike days but in the face of rota gaps and chronic workforce shortages, and with an emphasis on clearing the record treatment backlog. Crucially, the principle is to ensure that NHS trusts adopt a fairer and more consistent approach to overtime pay nationwide, with rates based on those already being offered in parts of the country to reflect the market value of doctors’ work.

“It is also intended to protect against burnout, setting out arrangements for time off in lieu rather than pay if doctors are being asked to do extra work, especially at short notice… 

”This letter, put together by grassroots doctors in the capital, emphasises the strength of feeling among the profession that their time, expertise and wellbeing are not being fairly and appropriately valued by trusts, and thus underlining the very reasons that the rate card was developed in the first place.”

Updated at 10.40am on 7 June with the BMA’s comment