Doctors’ leaders have accused NHS bosses of bowing to political pressure in a row over striking medics being called back to work.
The British Medical Association (BMA) has written to the chief executive of NHS England, Amanda Pritchard, to say the process by which striking junior doctors can be called back to work due to “unexpected and extreme circumstances” is at risk of collapse because of a failure by NHS bosses to follow it.
The BMA and NHS England have agreed a system for derogations, in which junior doctors return to work where there are safety concerns about emergency care, with NHS trusts expected to show they have “exhausted” all other sources of staffing before recalling medics.
The BMA said this has always worked well but now NHS England and some trusts are refusing to provide evidence that they have undertaken these steps.
In the letter to Ms Pritchard, BMA chairman Professor Philip Banfield, said: “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. NHS England, it seems, is wilfully placing the BMA in an impossible situation.
“A number of local negotiating committee leaders have told us that their employers decided to apply for a derogation well in advance of strike action and before alternative solutions could be pursued.
“In addition, consultants on the frontline in several of the departments we have received requests from, have expressed surprise that a derogation request has been submitted, telling us they are staffed safely.
“We are increasingly drawing the conclusion that NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action and push the BMA into refusing an increasing number of requests – requests, we believe, would not have been put to us during previous rounds of strike action.”
The BMA gave examples of “unevidenced assertions”, such as the NHS saying no consultants, specialty and associate speciality (SAS) doctors or advanced practitioners are working at all in some specialties; and no additional consultants or SAS doctors available to provide cover for junior doctors. It said this was “in stark contrast to previous rounds of action”.
The BMA also said some NHS trusts have refused to demonstrate they have sought alternative staffing, or have refused to detail efforts to encourage alternative staff to assist, such as through offering time off in lieu or more pay.
On Wednesday it emerged that more than 20 requests had been made by hospitals for junior doctors to return to work due to patient safety fears.
On the first day of the strike, more than a dozen hospitals said that emergency services were “busy” and Queen Alexandra Hospital in Portsmouth said its A&E department was “full” as it declared a critical incident.
A critical incident was also declared by NHS Nottingham and Nottinghamshire Integrated Care Board due to “significant pressures on services”.
Other hospitals reported “extreme heightened pressure” and being “exceptionally busy”, with one citing A&E waits of “up to 11 hours”.
An NHS England spokeswoman said: “The NHS has a robust process in place for seeking derogations from the BMA to prioritise the safety of our patients and this has involved providing strong evidence where the most challenged systems need support.
“Nationally, we will continue to support local medical directors and other clinicians as they work hard to deliver the safest possible services for patients.
“Given this period of industrial action coincides with the most difficult time of year for the NHS, it is to be expected that more senior medical leaders will ask their colleagues for allowances to be made to ensure safe levels of cover.”
Meanwhile, Health and Social Care Secretary Victoria Atkins has urged junior doctors to call off the strike and “come back to the negotiating table”.
Dr Vivek Trivedi, co-chairman of the BMA’s junior doctors committee, told the PA news agency: “I hope they (the Government) come back to the table now – but from all of the signals they are sending it won’t be until our strike action finishes. And I hope at that point we can come to a resolution.”
The BMA said junior doctors’ pay has been cut by more than a quarter since 2008.
Last summer, the Government gave junior doctors in England an average rise of 8.8%, but medics said the increase was not enough and ramped up strike efforts.
Late last year, the Government and junior doctors entered talks, but after five weeks, the negotiations broke down and more strikes were called.
Junior doctors from the Hospital Consultants and Specialists Association union will join colleagues on picket lines.
Consultants and SAS doctors have agreed on a deal with the Government, which is being put to members.
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