Manager and doctor ‘camaraderie’ eroded by strikes, ICBs warn

“Camaraderie” between NHS managers and senior doctors has been eroded during the past year of medical strikes, a review by several integrated care boards has warned.

Directors of six ICBs from different parts of England gathered to share and compare experience about the wider impact of the unprecedented actions, to seek to “fully understand the impacts upon healthcare… and upon the health of the population”.

A report on their discussions also warns of a “risk of major incident fatigue” and of strike preparations being treated as business as usual.

It says there was a consensus view that the “initial sense of camaraderie with consultants was seen to quickly fade and successive industrial action episodes has seen an erosion of this”.

There have also been challenges of “strained relationships” between “differing clinical disciplines and professional groups, but also between clinical and managerial colleagues”.

These relationship problems have made strike planning more difficult, according to the report on the talks, which was published in Bristol, North Somerset and South Gloucestershire ICB’s board papers this month.

There has been a strike by either junior doctors, or consultants, or both, in every month since last March, except May and November (see chart below). Junior doctors are set for a five-day walk-out from this Saturday to Wednesday (28 February), while consultants have not announced any further announcement after their membership voted very narrowly to reject a government pay offer.

The ICB directors’ reflections included a perception that there was a “business as usual shift with regards to the consideration of industrial action” and this “normalisation in itself poses a significant risk”.

Other findings included:

• The derogation process – whereby trusts can request doctors are exempted from striking in exceptional circumstances – was “universally experienced locally as having been challenging”. The process has been a focus of major tensions between the British Medical Association and NHS England nationally;
• Cancelled hospital activity would have a knock-on impact on primary care, with local evidence showing a quarter of GP appointments were directly or indirectly related to long waits for hospital care;
• The BMA “rate card” for consultants’ over time pay, and local determination of rates was “perceived as divisive” among NHS organisations.

The ICBs agreed their boards would consider some actions ahead of further strikes. These included:

• The risk that more routine elective work is pushed to the private sector, which can reduce NHS theatre utilisation metrics, and have “training implications”;
• Whether a methodology should be agreed to measure the impact of elective delays on primary care;
• Whether ICBs could work together collectively to influence derogation processes; and
• To consider the cost of diverted clinical and managerial time in responding to the strikes, and the impact this will have on efficiency and transformation programmes.

The ICBs which took part in the review were: Cambridgeshire and Peterborough, Derby and Derbyshire, West Yorkshire, Bristol, North Somerset and South Gloucestershire, North East London and Dorset. The representatives comprised chief executives, chief finance officers, chief nurses, chief medical officers and chief people officers.