Junior doctors strike: dates for BMA strike in April, what have NHS Providers said about patient safety?

Hospital leaders have expressed serious concerns about how they will be able to maintain patient safety during this week’s strike.

Junior doctors in England will stage their longest walkout between 11 and 15 April as part of a bitter row over pay.

The British Medical Association (BMA) said a 96-hour walkout will take place for shifts starting between 6.59am on Tuesday 11 and 6.59am on Saturday 15 April. The BMA added that Health Secretary Steve Barclay had failed to make any “credible offer”, accusing the government of not being serious about resolving the dispute.

It had previously been hoped that a deal could be agreed in advance of the industrial action.

The union is demanding “pay restoration” for junior doctors, who can have many years’ experience in the profession and make up about 45% of the medical workforce. It says their pay has fallen in real terms by 26% since 2008/09, and that reversing this would require a 35.3% pay rise.

Patient safety concerns raised over strike

Matthew Taylor, chief executive of the NHS Confederation, said that the strikes were putting patient safety "at risk" and could have a "catastrophic impact" on NHS waiting lists, which are already under strain. He told Sky News: “It’s going to be an incredibly tough week. We’ve got four days of industrial action which of course come after the Easter Bank Holiday weekend, followed by another weekend, so you’re talking about 10 or 11 days when the NHS is not able to operate at full strength.

“These strikes are going to have a catastrophic impact on the capacity of the NHS to recover services. The health service has to meet high levels of demand at the same time as making inroads into that huge backlog that built up before Covid, but then built up much more during Covid. That’s a tough thing to do at the best of times – it’s impossible to do when strikes are continuing.”

Mr Taylor added that there is a hope that there will be no impact to urgent care during the strikes, but warned: "There’s no point hiding the fact that there will be risks to patients – risks to patient safety, risks to patient dignity – as we’re not able to provide the kind of care that we want to.”

It comes after NHS Providers, which represents NHS trusts, said the timing of the strike and its duration present a “range of challenges over and above the disruption seen from the industrial action in recent months”.

It said that during the strike, the NHS will focus resources on emergency treatment, critical care, maternity, neonatal care and trauma. But even in these areas, there are “real concerns of a raised risk to safety”, it said.

The 96-hour strike is likely to be the most disruptive in the history of the NHS due to the length of the strike and the fact that doctors have chosen to take action directly after a long Bank Holiday weekend – which traditionally causes disruption to the NHS even without the prospect of strike action. The walkout also coincides with the Easter school holidays, which means that many consultant staff who provided cover during the first round of strikes will be unable to do so again due to pre-planned holidays and childcare commitments.

The strikes could also lead to delays for some patients starting treatment – for instance, if a new cancer patient needed to start weekly rounds of chemotherapy, the start of their treatment may be delayed until after the strike action to ensure continuity.

Hospital leaders have raised concerns with NHS Providers about the impact of the strike. One hospital trust chief executive said: “This is less about what planned routine work gets pulled down and everything about maintenance of safety in emergency departments, acute medicine and surgery. Concerned doesn’t begin to describe it”.

Another said: “I am not confident this time that we can maintain patient safety as we will not be able to provide the cover.”

A third said: “Many of the consultants who stepped up to do nights last time are not available or are more reluctant this time.” Another added: “Those with families almost certainly won’t as [they] can’t rearrange out of school holidays.”

What has the BMA said?

Dr Vivek Trivedi and Dr Robert Laurenson, co-chairs of the BMA junior doctor committee, said: “It is with disappointment and great frustration that we must announce this new industrial action. The Government has dragged its feet at every opportunity. It has not presented any credible offer and is refusing to accept that there is any case for pay restoration, describing our central ask as ‘unrealistic’ and ‘unreasonable’.

“Even yesterday they continued to add new unacceptable pre-conditions to talks instead of getting on and trying to find a resolution. We therefore have no confidence that without further action these negotiations can be successful.

“This situation is entirely of the Government’s own making. We want to spend our time looking after patients, not on strike, but with an NHS buckling under a workforce crisis, and four in 10 junior doctors looking to leave, we can’t stand by while our pay is further eroded by inflation and an intransigent Government.

“We are not going to stop until we are paid what we are worth, and if ministers don’t accept that when we tell them in person, we will have to tell them from the picket line.”

Barclay has called on junior doctors to follow the example of other health unions, who on Thursday (16 March) said they will recommend a pay deal to NHS staff including nurses and ambulance workers. “We have offered the same terms to the junior doctors that were accepted by the other trade unions and that is what I hope the junior doctors will respond to,” he said.

Why are junior doctors striking?

The BMA has said the government has excluded junior doctors in England from the 2022/2023 pay award process as their contract is still subject to a multiple-year pay deal. This went against the advice of the DDRB (Review Body on Doctors’ and Dentists’ Remuneration) which allows the amount to be revisited if the situation has changed, it said.

As a result of the global pandemic, cost of living crisis, and rising inflation, the union believes the situation has changed.

The BMA said successive governments have overseen 15 years of real-terms pay cuts for junior doctors in England, which amounts to a “staggering and unjustifiable” 26.1% decline in pay since 2008/09. The union also said patients are suffering and exhausted staff are burning out and leaving the NHS as a result, arguing that the government still “fails to see the crisis in front of it”.

BMA chair of the council, Professor Phil Banfield, said: “The situation is severe. A third of junior doctors are planning to work in another country. Four in ten say that as soon as they can find another job, they will leave the NHS. The health service will simply not be able to cope.

“For decades the NHS was the envy of the world. But without our doctors’ expertise, the country will get sicker. We will not accept impoverished healthcare for our nation, or acquiesce to those looking to slash pay and drive down living standards for NHS staff. In 2023 we will stand together with patients - an organised workforce ready to act.”

What are the strike dates?

The first 72 hour strike took place between 6.59am on Monday 13 March and 6.59am on Thursday 16 March. The next walkouts are between 11 April and 15 April.

How much does a junior doctor earn? 

A NHS doctor’s salary varies according to grade, years in a role, and where the job is based. In the case of ‘junior doctors’, they are qualified doctors in clinical training at a hospital or in general practice. They can be junior doctors for up to eight years in hospital, or for three years as a GP, before becoming consultants.

According to the British Medical Journal (BMJ), the 2016 contract in England for junior doctors removed incremental annual pay rises. Instead their salary increased by larger amounts at so-called nodal points - when junior doctors move up a grade - for example, the first day they work as a speciality register (core training).

For each grade, a junior doctor in England earns pre-tax:

Foundation Doctor Year 1

Stage of training: FY1

• Nodule point: 1
• Salary: £29,384

Foundation Doctor Year 2

Stage of training: FY2

• Nodule point: 2
• Salary: £34,012

Specialty Registrar (StR) (Core Training)

Stage of training: CT1

• Nodule point: 3
• Salary: £40,257

Stage of training: CT2

• Nodule point: 3
• Salary: £40,257

Stage of training: CT3

• Nodule point: 4
• Salary: £51,017

Specialty Registrar (StR)

(Run-Through Training or Higher Training)/ Specialist Registrar (SpR)

Stage of training: ST1 / SpR1

• Nodule point: 3
• Salary: £40,257

Stage of training: ST2 / SpR2

• Nodule point: 3
• Salary: £40,257

Stage of training: ST3 / SpR3

• Nodule point: 4
• Salary: £51,017

Stage of training: ST4 / SpR4

• Nodule point: 4
• Salary: £51,017

Stage of training: ST5 / SpR5

• Nodule point: 4
• Salary: £51,017

Stage of training: ST6 / SpR6

• Nodule point: 5
• Salary: £58,398

Stage of training: ST7 / SpR7

• Nodule point: 5
• Salary: £58,398

Stage of training: ST8 / SpR8

• Nodule point: 5
• Salary: £58,398