BMA ‘risking lives’ by blocking emergency strike exemptions

The NHS has accused the British Medical Association (BMA) of “risking patient safety” by refusing emergency requests to allow striking doctors to cross picket lines and return to work.

Since a five-day junior doctor strike began on Friday morning, the BMA has rejected 18 requests from NHS hospitals for doctors to break the strike to stop patients coming to harm, including in cancer care.

The exemptions, known as “derogations”, are requested by senior NHS medics in exceptional circumstances to protect patient safety, such as if there is a major accident.

They have to be agreed on a case-by-case basis by a committee of BMA leaders, including Dr Tom Dolphin, the union’s chairman, who specifies whether a doctor can go back to a particular ward.

The BMA said that NHS England made 47 derogation requests up until Sunday evening for 125 doctors, but that it had only agreed to nine of these requests. The remaining requests have been refused, withdrawn or are pending.

Thousands of resident doctors, formerly known as junior doctors, are out on strike until 7am on Wednesday as they pursue a 29 per cent pay rise.

Resident doctors protest outside Bristol Royal Infirmary during the first day of a five-day strike over pay and conditions

FINNBARR WEBSTER/GETTY

Hospitals were instructed to cancel as few procedures and appointments as they can safely manage, to minimise disruption for patients and prevent harmful delays to routine care, meaning some have kept 96 per cent of appointments running.

As part of this tougher approach to the BMA, Jim Mackey, the NHS chief executive, also encouraged hospitals to seek derogations in more circumstances. However, the BMA has said it will not approve the requests if they are for “non-urgent care” and that the record number of derogation requests reflects a “dangerous lack of planning” by NHS hospitals.

An NHS spokesman said: “The NHS is continuing to work hard to maintain more services than in previous rounds of industrial action, and early indications show the plan is working with the vast majority of planned care going ahead.

“Derogation requests for resident doctors to work in exceptional circumstances are being made by the most senior clinical teams on the ground, and delays or refusals by the British Medical Association questions their integrity and risks patient safety.”

Requests rejected by the BMA include for a resident doctor to carry out biopsies on men with suspected prostate cancer at Milton Keynes Hospital. The doctor subsequently voluntarily decided to break the strike to return to work, and Wes Streeting, the health secretary, praised their “bravery” and said it “ensured these men got the care they deserve”.

The BMA has granted requests, including for a doctor to return to work on the neonatal ward at Nottingham City Hospital. Three BMA members were also allowed to work an A&E night shift at the Northern General in Sheffield, which the union said was “due to the failure to train consultants” on a new electronic patient record system.

In another case, King’s College Hospital in London had a derogation agreed for its radiology department, but the BMA then revoked it and said the hospital had made a “false submission”. King’s said its request was made in good faith.

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Dr Melissa Ryan and Dr Ross Nieuwoudt, the BMA’s resident doctors committee co-chairs said: “Patient safety remains our highest priority during strike action. We rely on NHS England to ensure that safety by planning services in line with the levels of staffing available. If a critical event or an emergency occurs, we work with them to make sure staff can be called back into work on a voluntary basis. This agreement — called a national derogations process — is there strictly to be used should a safety-critical, urgent event occur. It is deeply irresponsible for hospitals to use it to facilitate non-urgent care or cover for poor planning on their part.

“Unfortunately, the number of derogation requests during this strike round has greatly exceeded that in previous rounds, far more even than NHSE [NHS England] are publicly acknowledging. We therefore have to question why NHSE has failed to plan properly. So far, we have had to revoke two derogations where it was proven that the hospital had either been misinformed about their own staffing, or had deliberately misled us.

“We need NHS England to be honest about their failure to plan appropriately which has led to Trusts relying on the BMA to bail them out. It is imperative that this does not happen again for any future strike action — which we hope will not be necessary.”

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Streeting has thanked staff working to minimise disruption and insisted the country “will not be held to ransom by the leadership of the BMA”. He added: “I particularly want to thank resident doctors who didn’t take part in these strikes and went into work to help their colleagues and patients.

“I’ve been on calls with operational leaders and frontline clinicians, and I’ve been inspired by the stories of what NHS staff are doing to pick up the slack left by striking resident doctors. I’ve also spoken with patients directly affected by their actions.”