In previous rounds of strike action over the past decade, it was agreed that elective or scheduled procedures must be postponed to free-up senior doctors to cover for resident doctors in emergency and urgent care, maintaining safe services.

However, for this year's strikes - which are due to begin on Friday (25 July), the chief executive of NHS England Sir Jim Mackey has instructed hospitals to continue scheduled non-urgent care.

Following a meeting with NHS England today (21 July), the BMA has written to Sir Jim, outlining its concern that this change in direction is not only causing frustration and confusion to hospital leaders, but that it will put patients at risk.

The letter, from BMA council chair Dr Tom Dolphin and deputy council chair Dr Emma Runswick, says: ‘It is vital that hospital care must adapt on strike days to the levels of staff available, as the foundation of ensuring that strikes are safe for patients is that more senior doctors are able to cover for those residents who are on strike in all urgent care. Your decision to instruct hospitals to run non-urgent planned care stretches safe staffing far too thinly, and risks not only patient safety in urgent and emergency situations, but in planned care too. It also appears designed to lead to far more late, same-day cancellations for patients. Consultants cannot safely provide elective care and cover for residents at the same time.

‘We are aware that many hospital leaders are equally worried about this new change in policy from NHS England, which is starkly different from how services were planned during industrial action under the previous government, and different to all the agreements we have reached with NHS England since 2015. 

‘We therefore strongly urge you to reconsider your instructions to hospitals, which should be preparing now to postpone non-urgent planned activity in order to provide a safe urgent and emergency service in keeping with the levels of staff available.'

In addition to the cancellation of scheduled, non-urgent procedures, the BMA and NHS England had previously agreed a national ‘derogations' process, whereby hospitals can request to have striking doctors return to work in the event of an unforeseen emergency or mass casualty event.

The BMA says it is still committed to this process, but that it must not be used to facilitate non-urgent planned care going ahead on strike days.

In response, Professor Meghana Pandit, NHS England co-national medical director (secondary care), said: ‘The safest thing for patients is for the NHS to maintain as much urgent and planned care as possible during strikes, and we would encourage the BMA to work with us constructively to achieve this in the event industrial action goes ahead.'

Daniel Elkeles, chief executive, NHS Providers, added: ‘The NHS, not the BMA, is putting patient's interests first. Given that some patients will be caused undoubted harm if the short-notice strike goes ahead, NHS trusts are doing the responsible thing by not cancelling people's care whilst talks to avert the strike are ongoing. 

‘Now is a time for cool heads in the BMA because it's not too late to avoid a damaging, costly strike. NHS trust leaders hope for a breakthrough from talks between government and the union. If the strike goes ahead then NHS trusts will do everything they can to avoid any harm to patients and are planning for as many patients as possible to be cared for.'