Doctors' strike: hospitals face bill of £4,000 a shift
The British Medical Association (BMA) has relaunched its rate card that sets out the levels of pay senior doctors should demand when they work extra shifts or are asked to fill in.
It is part of the BMA's dispute with the government and threatens to land hospitals with costly bills. Many hospital trusts are already cutting jobs and trying to save millions in an effort to shrink a £2 billion spending black hole this year.
Resident doctors are planning a full five-day walkout from 7am on Friday, July 25, after Wes Streeting refused to negotiate any increase to the 5.4 per cent pay increase for resident doctors this year.
In the previous rounds of strikes doctors took 44 days of action, including eight separate walkouts in 2023. An internal report from NHS England reveals the impact on thousands of cancer and heart patients, as well as sick babies and mothers needing a caesarean section.
Separate documents shared with BMA members last year, before they agreed to end strikes and receive a 28.9 per cent pay rise, show the association's resident doctor committee was always preparing for the possibility of further industrial action. They outline the union's 'bank and build' approach to take the deal and then push for more.
Streeting, the health secretary, has said that if this month's five-day strike goes ahead he may not be able to prevent job losses given the tight financial constraints on the NHS.
• Public turning against 'unjustifiable' doctor strike, poll shows
During the strikes, consultants will be able to increase their pay significantly. Their basic starting salary is £109,000 for a 40-hour week but, according to the BMA rate card, a consultant asked to work a weekend night shift in London should demand £334 an hour, or £4,008 per 12-hour shift.
Outside London, consultants are advised the minimum they should accept for a weekday shift between 7am and 7pm is £188 per hour, or £2,256. A weekend day shift outside London would earn them £3,000 and a weekend night shift would bring in £3,756.
Matthew Taylor, chief executive of the NHS Confederation, which represents NHS organisations, said budgets were 'squeezed' and hospitals were having to make tough choices on what they could afford.
'Trusts are already having to make significant savings this year, and NHS leaders will be very worried if they are forced to use their scarce resources to pay higher rates to cover medical shifts, particularly during prolonged strikes by resident doctors,' he said.
The BMA's 'bank and build' strategy document shows that last year's deal was viewed by union leaders only as 'an initial step' on its longer campaign to restore pay back to what the union claims it was worth in 2008.
Insiders say the strategy was modelled on the actions of the RMT railway union and shows that there was nearly ten months of preparation before the current dispute. The RMT has regularly held strikes in long-running disputes with train operators and Transport for London, leading to Tube drivers' pay rising by 34 per cent in the decade to 2022.
The BMA document says: 'This strategy will be adopted in full should the current offer be accepted by the membership via a referendum. 'Bank and build' is an industrial strategy used by unions to lock in progress either while pursuing an ambitious industrial objective or defending a previously obtained win that their employers may seek to reverse.
'In both these scenarios, the union is likely to require industrial action that is sustainedand escalated.'
The document describes how the BMA planned to use the ten months from the deal being accepted to re-engage doctors over the issues of pay. Activism would be encouraged on the ground in hospitals with events such as 'pizza and pay' sessions, where union reps would meet doctors and encourage them to support any strike.
As part of the strategy, the BMA set a threshold for starting a new dispute by saying only that any new pay offer had to be 'sufficient'. It argues the latest 5.4 per cent does not meet that goal, despite it being the highest in the public sector.
The impact of eight separate strikes by trainee doctors in 2023 was examined by NHS England and reported to its board's quality sub-committee. The report, dated December 2023, and obtained under the Freedom of Information Act, details how the walkouts led to thousands of cancer and heart operations being delayed.
The internal report said:
● 6,500 cancer operations were cancelled, 31 per cent of expected activity. Surgery for fast-growing cancers such as head and neck cancer, upper gastrointestinal, and lung cancers dropped by between a quarter and a third. A delay of just four weeks is linked to an 8 per cent increase in the chance of death, the report said.● There were delays to urgent admissions to neonatal care due to the availability of doctors as well as delays to elective caesarean sections and urgent inductions.● Heart surgery dropped by almost 10 per cent in 20 out of 28 cardiac centres and urgent heart operations fell by 13 per cent.● 148 corneal transplant operations were cancelled and there was a 42 per cent fall in other eye operations.● In mental health hospitals patients faced long delays to be discharged, admitted, assessed or have their medication reviewed.
The report said strikes had caused 'a significant unavoidable impact' on planned surgery, adding: 'Medical research overall is clear an increase in waiting times for elective care can cause harm, and in many specialties the risk of delays to emergency and urgent care is well-evidenced.'
Dr Tom Dolphin, the BMA's chairman, said keeping patients safe during strikes was 'very important' to the union and it would look to agree a series of derogations, where doctors return to work in the event of safety concerns being raised with NHS England.
He added: 'Achieving full pay restoration has been BMA policy since 2022 and the 'bank and build' strategy, developed last year and a recognised industrial strategy, is phase two of the campaign to achieve full pay restoration for resident doctors in England and something the government has been aware of since its inception last year.'
• Who is the BMA leader behind new wave of doctor strikes?
Dolphin defended the extra pay for consultants covering shifts, arguing the 4 per cent pay offer for consultants this year was 'another real-terms pay cut'.
'The rates vary depending on time of day but reflect that this is additional work, done by our most expert clinicians, out of choice,' he said.
NHS England said: 'It is really disappointing that further strike action has been announced. We have, of course, begun preparations for limiting, as far as possible, the impact industrial action might have on patient care, whilst recognising that disruption to services is sadly inevitable if this action goes ahead.'
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