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| Junior doctors' strike 'unjustifiable in struggling hospitals' | Junior doctors' strike 'unjustifiable in struggling hospitals' |
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| Junior doctors have been warned by the profession’s regulator that patients may be harmed during their all-out strikes next week in hospitals that struggle to cope in their absence. | |
| The General Medical Council has told trainee medics working in areas of life or death care – such as A&E, intensive care and maternity services – that they should think twice about joining in the first total withdrawals of medical labour in the NHS’s history. | |
| In tough new guidance to doctors on their responsibilities during industrial action, the GMC also made clear that medics who go on strike could be at risk of being disciplined or even struck off if their actions “had caused patients serious harm” during walkouts because it was not possible to deliver care as needed. | |
| The regulator said that, while it recognised junior doctors’ “anger and frustration” at the new contract health secretary Jeremy Hunt is threatening to impose on them, patient safety had to be the top priority. | |
| “We ask every doctor contemplating further and escalated industrial action to pause and consider again the possible implications for patients, not only in terms of the immediate action but also in terms of the cumulative impact on patients and the additional risk posed by the withdrawal of emergency cover,” its updated advice states. | |
| Unknown numbers of the 45,000 medics below the level of consultant will strike between 8am and 5pm next Tuesday and Wednesday. Unlike their four walkouts since January, the stoppages will see junior doctors refuse to work in any hospital department, even those in which lives are at stake. | |
| The guidance states: “The GMC cannot second guess the situation facing each doctor in training in England – that must be a matter for individual judgment. But given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, some hospitals may struggle to cope. | The guidance states: “The GMC cannot second guess the situation facing each doctor in training in England – that must be a matter for individual judgment. But given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, some hospitals may struggle to cope. |
| “In these cases where local circumstances are particularly acute, the right option may be not to take action that results in the withdrawal of services for patients.” | “In these cases where local circumstances are particularly acute, the right option may be not to take action that results in the withdrawal of services for patients.” |
| Several leading doctors – including Prof Sir Bruce Keogh, the former health minister Ara Darzi and the chief medical officer, Prof Dame Sally Davies – have recently urged junior doctors to think hard about the risk of patients being harmed. Dr Sarah Wollaston MP, the ex-GP who chairs the Commons health select committee, has urged juniors to keep providing A&E and maternity care next week. | |
| But the British Medical Association (BMA) reassured patients that care will be safe on strike days because consultants will undertake junior colleagues’s roles. “The critical message for patients is that anyone who needs emergency care during the days of industrial action will get it, the difference is that it will be provided by senior doctors rather than junior doctors”, said Dr Johann Malawana, chair of the doctors’ union’s junior doctors committee. | |
| The GMC did not define when it would describe a hospital during a strike as ‘struggling to cope’. But a lack of staff – most hospitals have too few medics – or a sudden heavy demand for emergency care, for example caused by a multi-car accident, could cause such a situation. | |
| Asked if striking doctors could face disciplinary proceedings in the event of a patient coming to harm, a GMC spokesman said: “While we would not take action against a doctor for exercising their legal right to take industrial action, we would investigate information suggesting that a doctor’s actions during the taking of such industrial action had caused a patient serious harm, or put patients at risk of serious harm, whatever the motive underlying the doctor’s actions. It would all depend on individual circumstances.” | |
| It said striking doctors should return to work immediately if patients became “at risk” because consultants could not cope with the workload. “Where contingency plans are overwhelmed, it is vital that doctors taking action can be contacted and are available to help,” it added. | |
| The BMA has made a last-ditch attempt to prevent the walkouts by offering to call them off if Hunt drops his threat to impose the contract and resume talks over the detail of their terms and conditions. But the health secretary said there was no point in resuming talks unless the doctors’ union was willing to talk about the key issue of pay rates for working on Saturday. | |
| Related: Withdrawing emergency cover crosses a line – it will damage trust in doctors | Related: Withdrawing emergency cover crosses a line – it will damage trust in doctors |
| Junior doctors gave the updated guidance a mixed reception. | Junior doctors gave the updated guidance a mixed reception. |
| Malawana said patients would not come to harm. “While junior doctors understand and deeply regret the disruption caused to patients, they fundamentally believe that the contract the government is trying to impose is both unfair and will undermine the delivery of patient care in the long term,” he said. | |
| National Voices, which represents 160 health and social care charities, said patients in some hospital units providing life-or-death care would be at particular risk next week. | National Voices, which represents 160 health and social care charities, said patients in some hospital units providing life-or-death care would be at particular risk next week. |
| “The GMC has stated that some hospitals will struggle to cope. This is significant as it is the first official acknowledgement that patients could be put at increased risk by the all-out strike action,” the NV chief executive, Jeremy Taylor, said. | “The GMC has stated that some hospitals will struggle to cope. This is significant as it is the first official acknowledgement that patients could be put at increased risk by the all-out strike action,” the NV chief executive, Jeremy Taylor, said. |
| “We agree with the GMC about these risks, though in fact they are likely to lie with particular units and services rather than whole organisations. | “We agree with the GMC about these risks, though in fact they are likely to lie with particular units and services rather than whole organisations. |
| “Doctors have a duty to do the best for patients, and they also have a right to strike. The GMC guidance is welcome for making it clear that these two things are inevitably in tension and that doctors must think carefully about the impact of their action on patients.” | “Doctors have a duty to do the best for patients, and they also have a right to strike. The GMC guidance is welcome for making it clear that these two things are inevitably in tension and that doctors must think carefully about the impact of their action on patients.” |
| Four prominent junior doctors give their reaction to the GMC’s new advice: | |
| Dr Rachel Clarke | |
| “As a doctor, I weigh risks and benefits every day and, after long and careful deliberation, my conscience requires me to strike next week. I have enormous faith in my consultant colleagues to safely manage my patients in my brief absence next week. Provided local trusts have responsibly cancelled elective activities next week on strike days, there is no reason why consultants in their thousands are not perfectly capable of protecting our patients. | |
| “While the GMC is quite right to highlight concerns about the ‘cumulative impact’ of strikes on patients, particularly in areas where hospitals are understaffed, they have failed to acknowledge the deeply corrosive impact of this contract on patient safety in the wider context. In decimating the morale of junior doctors, in driving us away from the profession in our droves, imposition of this contract is a far greater long-term risk to patient safety than the industrial action we take with such heavy hearts. | |
| “I believe the single most effective act the GMC could do now to promote patient safety would be to lobby Jeremy Hunt to get back round the table and talk. At a stroke this would end next week’s industrial action.” | |
| Dr Francesca Silman | |
| “These contracts are so toxic and dangerous to the future safety of patients within the NHS that we cannot stand idly by and not take action. There is already a staffing crisis within the NHS and doctors are struggling on a daily basis to cover rota gaps due to shortages of doctors. | |
| “We have highlighted time and time again to the government that these dangerous new contracts will only exacerbate this problem. We are considering the long-term implications of our actions and only want what we feel is best in the interest of our patients and the NHS.” | |
| Dr Ben White | |
| “Trusts have had enough time to ensure patients will remain safe. If a trust has prepared appropriately, the service on the strike days will be of a higher quality and safety than normal. For example, on a local level I can be sure that my resuscitation team will comprise resuscitation officers, experienced nurse practicioners and acute medical consultants qualified with advanced life support. | |
| “However, it is important to note that trusts have had plenty of time to prepare adequately by cancelling elective work. If there is a patient safety incident and it appears that the hospital executive had not adequately prepared, because consultants were either not present or doing elective work, or that enough auxillary staff were not booked, that would be a serious untoward incident on the behalf of the trust.” | |
| Dr Roshana Mehdian | |
| “The GMC have reiterated a position we all hold: to consider the local circumstances and weigh up the risks before we take an action. That is something we do daily in our jobs as doctors, whether it’s offering a procedure, a test or a drug. | |
| “Every doctor, including myself, makes these assessments before taking strike action. | |
| “The BMA also has procedures in place to call doctors in when and if necessary, to which every doctor would respond when needed. | |
| “All in all, they are reiterating considerations we all already take. We are being forced to strike due to the bullishness of this governments actions despite great opposition to this unsafe and unfair contract from doctors and patients alike. The strike is wholly preventable if the government were to accept the offer of mutual deescalation made by the BMA today; to cancel the strike if the government drops imposition.” |