The NHS may have to cut frontline staff plus appointments and operations for patients if doctors’ strikes continue, health leaders have warned.
As thousands of resident doctors go on strike across England from 7am on Friday in a dispute over pay, the NHS Confederation and NHS Providers, which represent health trusts, said continued action was piling pressure on already-stretched budgets.
The five-day action from Friday is the 13th walkout by doctors since March 2023, with the last strike in July estimated to have cost the health service £300 million.
NHS Confederation and NHS Providers said that if the NHS continues to have to foot the bill from strikes, it could lead to staff being cut and fewer tests, appointments and operations being carried out.
The knock-on impact on patients is they will be forced to wait longer for care, and many may no longer be able to work without the treatment they need, they said.
The groups also warned that strikes are hitting progress in bringing down NHS waiting lists. Figures on Thursday showed early signs the waiting list is dropping, with September seeing a slight fall after three consecutive months of rises.
The strike comes as polling in The Times suggested 48% of resident doctors wanted the action called off, and only 33% thought it should go ahead.
The last time resident doctors went on strike, more than 54,000 procedures and appointments needed to be cancelled or rescheduled, despite the NHS maintaining 93% of planned activity.
NHS Confederation chief executive, Matthew Taylor, said: “There is no doubt that patients will bear the brunt of this disruption, with tens of thousands of tests, appointments and operations likely to be delayed or cancelled.
“NHS leaders understand how frustrating this will be for them being left waiting in pain or discomfort, not knowing when their treatment will be rescheduled.
“With flu already beginning to bite there is a real risk that these strikes will leave the NHS limping into a very difficult winter at a time when it is trying to recover performance and implement vital long-term reforms.
“But industrial action is also having a major financial impact on the NHS, with the last five-day walkout estimated to have cost a staggering £300 million.
“These costs are not included in the health service’s budget, which is already very tight given the strain on public sector finances.
“This means that more strikes will blow further holes in these constrained budgets and could result in leaders having to cut staff or reduce service levels in order to balance the books.”
Mr Taylor said the British Medical Association (BMA) “must recognise that these strikes are disproportionate, given the current financial environment and the fact resident doctors have already had one of the biggest pay rises in the public sector.”
He said: “We would urge them to call them off, moderate their demands to something achievable and re-enter negotiations.”
Health secretary Wes Streeting has refused to move on the issue of pay for resident doctors, saying they have received an almost 30% increase in pay over three years.
But the BMA argues doctors need a 26% pay uplift to restore their earnings, once inflation is taken into account.
On Thursday, the BMA said doctors must not be called off the picket lines to cover planned NHS work during the strike.
The union said it would not agree to “derogations” – where resident doctors are asked to leave the strike and work when patient safety is at risk – unless NHS trusts have already cancelled planned activity and “incentivised” other medics to provide cover.
Dr Tom Dolphin, BMA council chair, and Dr Emma Runswick, deputy chair, told hospital leaders in a letter that derogations are “not in place to avoid disruption caused by industrial action but to ensure that in unexpected and extreme circumstances patients will continue to receive safe care”.
The letter said: “Derogations will not be granted if planning has not occurred to incentivise non-striking doctors to cover emergency work, or if non-emergency work is continuing.”
It comes after NHS England chief executive, Sir Jim Mackey, told hospital bosses earlier this week to deliver at least 95% of planned activity and “not to adopt” the BMA’s rate card to pay medics covering for striking doctors.
Sir Jim told hospital chief executives that rescheduling appointments and operations should “only happen in exceptional circumstances to safeguard patient safety”.
His letter also said that if non-striking doctors provide cover during the strike, trusts “should not adopt the BMA’s rate card”.
The BMA’s consultant rate card for working outside contracted hours sets a fee of £188 per hour for weekdays from 7am to 7pm, and £250 per hour for 7pm to 11pm.
Weekends are 7am-11pm for £250 per hour, and overnight shifts of 11pm to 7am are £313 per hour.
Chief executive of NHS Providers, Daniel Elkeles, said patient safety was the number one priority.
“Trust leaders and their frontline teams are working flat out to manage the impact of industrial action, including asking other senior staff to step in and provide essential cover for their striking colleagues, while doing their own jobs,” he told the PA news agency.
“Derogation requests during strike action aren’t made lightly. These requests are initiated by trust-based medical directors, who are senior clinicians acting in good faith, to keep patients safe when unexpected and extreme circumstances arise during strikes.”
The BMA’s current mandate for strike action runs out in January after which it would need to ballot members.
Dr Jack Fletcher, chair of the BMA’s resident doctors committee, accused NHS managers of “emotionally blackmailing frontline staff who are taking legitimate industrial action to defend their pay and conditions, and fight for employment”.
He said that strikes “have not come out of the blue”, adding: “What has been offered so far still leaves thousands of resident doctors without a role this year, and the Government seems determined to cut pay even further next year.”
Dr Fletcher said “any resident doctor” would challenge the narrative that the NHS is “somehow turning a corner”.
“We have doctors sitting on bins because there aren’t enough chairs, patients routinely being seen in corridors, A&E waits through the roof and rota gaps are an accepted norm,” he said.
“We cannot let the Government and managers gaslight the public into putting the blame for these system-wide failures at the doors of hardworking doctors who are standing up for their profession and the future of the health service.”
NHS England is urging patients to continue coming forward for care and attend any planned appointments unless they hear otherwise.
Patients who need emergency help should continue to use 999 or A&E as normal, while NHS 111 is also available alongside usual GP services.
