NHS bosses and the British Medical Association are accusing each other of endangering patients during the ongoing resident doctors’ strike.
Their war of words centres on “derogations”, local agreements under which doctors who have joined the strike can cross picket lines to provide clinical care in a hospital.
Thousands of resident – formerly junior – doctors in England are nearing the end of a five-day stoppage, part of their campaign for a 29% pay rise, which ends at 7am on Wednesday.
The escalation of the resident doctors’ pay dispute comes as it emerged that nurses in England, Wales and Northern Ireland have voted to reject their 3.6% pay award for this year.
Their decision, revealed in a survey run by the Royal College of Nursing seeking members’ views on what the union had called a “grotesque” award, makes it more likely that the NHS in different parts of the UK could face industrial action over pay by various groups of staff later this year.
Well-placed sources say the results of the union’s online survey of 345,000 members in the three countries, which is due later this week, will show a “clear” rejection of the 3.6% uplift.
The BMA and NHS England have become embroiled in a disagreement over the circumstances in which the doctors’ union agrees to a request by senior doctors locally to grant a “derogation”.
NHS sources claim the BMA is taking an “increasingly hardline approach” to such requests. In one case the BMA refused a plea for a resident doctor – one below the level of consultant – to return to Milton Keynes university hospital to help staff a prostate cancer biopsy service.
The union declined the request because it judged that there was no urgent clinical need for the doctor to return to work, in line with its policy that derogations should be for emergency situations only.
NHS England says the BMA had by Sunday rejected 18 requests for derogations during the strike – the 12th involving training-grade doctors since 2023 – and granted nine.
An NHS spokesperson said: “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.”
However, the BMA told members via social media on Sunday that it had received 47 requests and as a result agreed that 16 resident doctors, from a total of 125 the NHS asked for, could break the strike and return to work. For example, over the weekend a doctor went back in to help staff the neonatal intensive care unit at Nottingham city hospital while three others provided cover overnight at the Northern general hospital in Sheffield.
The union claimed NHS chiefs were asking for too many derogations because they had failed to ensure that some hospitals had enough medics on duty to cover for striking resident colleagues.
“Unfortunately, often due to poor timing of requests … there have been some situations where patients’ safety has been at risk, with not enough doctors to ensure emergency care, leading to last-minute derogations,” it said in a social media post.
“These hospitals have a lot to answer for, to the resident doctors, and the patients they have failed.”
Senior NHS officials say that fewer resident doctors have joined the ongoing strike compared with the 11 walkouts that junior doctors staged in 2023 and 2024 and also that more planned hospital activity – operations and outpatient appointments – had gone ahead this time round.
One well-placed source estimated that whereas about 80% of eligible doctors took part in the previous strikes, the figure appears to have dropped to about 60% in this stoppage.
“Participation is lower this time. Some resident doctors are less comfortable going on strike this time round, after the 22% pay rise over two years they got last year.
“There’s less sympathy among other NHS staff for resident doctors this time. And there’s frustration about how quickly they went on strike so soon after their significant pay rise.”
The BMA will try to increase the pressure on Wes Streeting, the health secretary, on Tuesday by picketing King George hospital in Ilford, the main hospital that provides care to people in his Ilford North constituency.