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Doctors strike over pensions shakeup – live coverage Doctors strike over pensions shakeup – as it happened
(about 4 hours later)
6.06pm: Here is a summary of today's key events so far. 9.00am: Hello, and welcome to today's live coverage of the first doctors' strike in almost 40 years.
• A large minority of GPs' surgeries have been affected in some way by today's industrial action by doctors, the first such action in almost 40 years. According to the Department of Health, a quarter of surgeries have been affected, while the British Medical Association says the figure is a third. Doctors are protesting against changes to their pensions that they say are unfair and unnecessary. The effect of the industrial action – over changes to doctors' pensions that they regard as unfair and unnecessary – is difficult to predict.
• Unlike in most industrial disputes, however, those who are taking part are still turning up to work and dealing with urgent and emergency cases; only routine and non-urgent appointments have been postponed. About one in 10 patients who were due to receive routine or planned non-urgent NHS care today have had it postponed, according to the DoH. The BMA says that figure is more like 25%. Not all doctors are taking part. About a third do not belong to the British Medical Association, which has called the action, and when the BMA balloted its members last month 21% of GPs and 15.7% of hospital consultants said they would not participate, on turnouts of 53.1% and 56% respectively.
• Andrew Lansley, the health secretary, said he was pleased that "the majority of doctors" had maintained services for patients, but added: "Thousands of patients who expected to have an operation or an appointment today have been inconvenienced or distressed by delay to their care" (see 2.33pm). The BMA's Hamish Meldrum said: "Our intention was not to maximise impact on patients, but to communicate the scale of doctors' angers and to encourage the government back to the table" (see 2.44pm). Later Lansley was more emollient, saying: "When you look at the number of doctors who've taken part in strike action, is not that they don't necessarily have a grievance about their pension arrangements, but that they don't think it's right to prejudice patients, they don't think it's right for patients to suffer or to be distressed as a consequence of that, and they put patients first. The BMA should ... join the other trade unions ... who are discussing with us the implementation of the agreement we collectively arrived at. " Nevertheless, services in hospitals and GPs' surgeries in many areas will be affected. But unlike in most industrial disputes, doctors will still attend their workplaces as usual, continuing to deal with urgent and emergency cases, and only refusing to attend to routine and non-urgent appointments and consultations. So it should be business as usual in A&E departments, maternity units, for renal and cancer patients, and anyone needing an urgent diagnostic test or end-of-life care, while 80% of UK hospitals, according to the BMA, have cancelled some planned operations and some outpatient appointments.
• The BMA accused the government of making "misleading" comments about doctors' pension reforms and of presenting "partial representations of the facts" (see 12.42pm). Andrew Lansley, the health secretary, has claimed that 30,000 operations will be cancelled, 1.25m GP appointments delayed, 58,000 diagnostic tests postponed, and 200,000 outpatient appointments rescheduled. But there is no way of verifying these figures because the Department of Health has asked NHS trusts not to release such details to the media. The DoH may release a summary of the impact later on today.
6.06pm: In Northern Ireland, a total of 897 patients were affected by either cancelled appointments or cancelled operations today, according to the NHS. We will be reporting on the impact of the doctors' day of action live here throughout the day.
The BMA said that more than half of GPs' practices participated. 9.11am: The BMA and the health secretary have already been taking to the airwaves to put their sides of the story. On Radio 4's Today programme, Hamish Meldrum of the BMA (left) was repeatedly asked whether doctors were putting at risk their enviable public standing by taking industrial action today.
We have had no NHS figures for Wales yet, but the BMA claims that at least 50% of routine GP appointments and a range of surgical concerns have been cancelled. "Almost every hospital site in Wales has participated," said a BMA spokeswoman. "Of these sites well over 50% and up to 75% staff participation." Meldrum said: "Just to emphasise, no patients are being put at risk … We have to respond to what our members say, and they pretty overwhelmingly said that they were angry and they wanted to take this action. Nobody is happy about taking any action which inconveniences patients, but the nature of a doctor's job means it's almost impossible to find anything that won't do that. So that's why we emphasise public safety. I really hope that we can find a resolution to this. Nobody is happy about this. No doctor wants to do this."
5.59pm: Yesterday doctor and journalist Kate Adams spoke to a consultant who mentioned that the management team at Newcastle Hospitals has a reputation for being aggressive towards staff during times of industrial action. She has just heard from one their junior doctors: On ITV's Daybreak, Meldrum responded to Andrew Lansley's claim that the strike would be "pointless".
Lots of frustration from juniors in Newcastle Hospitals who wanted to take action but were prevented by trust policy which states that all ward-based in-patient activity must continue. Very disappointing. A robust challenge to the Trust's obstructive management style would be needed in advance of any further days of industrial action here. I hope [the action] is not pointless and futile because we are very anxious to seek a resolution to this dispute and if this helps to highlight the problem and to get to that resolution then I hope it will have some point to it …
Dr Tim Walls, Newcastle's medical director, responded: We doctors have enjoyed a good relationship, high trust, with their patients and we don't want to do anything to get rid of that, but what we feel we've had is lack of trust from the government.
The trust recognises in principle the right of an employee to take lawful industrial action in response to a national dispute and there has been very good cooperation from the BMA in enabling the trust to deliver emergency and urgent care. We simply don't recognise the behaviour alleged by a junior doctor. We negotiated a deal on pensions four years ago that meant that doctors would work longer, they would pay more and that they would take the risk of any future increase or impact of people living longer on the pension scheme and the government has walked away from that deal. I hope that after today we can sit down and we can talk.
Hospitals elsewhere seem to have been more reasonable. One of the consultants in Sheffield told me that the hospital had been very reasonable wanting to work with the union and recognising that this is a national not a local disagreement. On the same programme, Lansley urged doctors not to participate:
5.29pm: The BMA has strongly disputed the government's assessment of the impact of today's action and claimed it led to much more disruption than ministers admit, Denis Campbell reports. I know doctors don't want to go on strike. I hope they don't. I think if they have an argument and they're angry, they're angry with the government and that's our job to represent the taxpayer and the public interest, and maybe we will have that argument. But I can't see why anybody thinks there is any benefit in penalising patients. It won't serve any purpose whatsoever.
The Department of Health's figures should be "treated with extreme caution", the union says. While the DoH claimed that 9% of normal daily non-urgent elective operations had to be rescheduled, the BMA says the true figure was more like 25%. The last time doctors took action was in 1975, when consultants suspended goodwill activities and worked to contract over a contractual dispute, and junior doctors worked to a 40-hour week because of dissatisfaction with the progress of contract negotiations.
Similarly, it also disputes the DoH's claim that three-quarters of GPs' surgeries in England offered the full range of normal services. One third joined the action, it insists. 9.37am: Andrew Lansley, the health secretary (left), has also accused the BMA of wanting a pension deal that would decrease those of lower-paid NHS staff. He said:
Here's the statement the BMA has just released: We needed something that was fairer for other NHS staff as well. The contributions do need to be properly progressive and they do need to reflect the highest paid paying a greater proportion into their pensions overall.
"Because doctors have been in their places of work as usual, it was always going to be difficult to put a figure on the number taking part - the government's figures need to be treated with extreme caution. Our feedback from the doctors co-ordinating the action on the ground indicates that in England up to a quarter of non-urgent cases have been postponed, and around a third of GP practices have been taking some form of action. Our intention has not been to maximise the impact on patients, but to communicate the scale of doctors' anger and to encourage the government back to the table. Doctors have sent a strong message that a fairer approach must be found." He said that current arrangements meant that often the highest paid received twice as much back in pension benefits than lower-paid staff.
5.25pm: Andrew Lansley has just been speaking on BBC News. He said: I'm afraid we are in a position where the BMA are out on their own and what they seem to be aiming for is to try and change things back so they get more and nurses and porters and others in the NHS get less.
I really do hope that the BMA now works with us to ensure that patients have their appointments and treatments as quickly as possible. Dean Royles, director of NHS Employers, which represents hospital trusts in England, said patients awaiting an operation to remove a cataract or benign lump, or replace a worn-out hip or knee, were among those whose care had been postponed, but only in some places. "I don't have any hard numbers [of patients affected] but in some places it will be very disruptive and in other places it will be very minimal."
The health secretary said pension negotiations had been taking place for over a year. The changes related not just to doctors' pensions, but to those of all NHS staff, he said. 10.31am: Below the line, onegpprotest writes about his/her local protest:
I can't see why anyone would imagine that the BMA are right in saying that they have to take strike action in order to be heard. We've continuously listened to the BMA … So I'm afraid the BMA's motivation is unclear. Clearly taking action that prejudices patients' care is completely unjustified. Our GP practice is open and working as usual. I have just sent an unwell man into hospital.
However, he appeared to row back from that harsh language almost immediately: But we are wearing protest badges and have put up information in the waiting room as to why we are protesting. This is our version of "industrial action".
When you look at the number of doctors who've taken part in strike action, it is not that they don't necessarily have a grievance about their pension arrangements, but that they don't think it's right to prejudice patients, they don't think it's right for patients to suffer or to be distressed as a consequence of that, and they put patients first … The BMA should simply take that message and join the other trade unions, like the Royal College of Nursing and Unison, who are discussing with us the implementation of the agreement we collectively arrived at. The BMA has been pretty useless at highlighting the structural underlying problem and as a result doctors have come across as greedy.
5.09pm: The Department of Health has released its final figures on the impact of the strike today. Suggest you read these two letters to the Lancet, one of them by Tower Hamlets GPs which is where I work.
The DoH says about 2,700 non-urgent operations were cancelled in England and 18,750 outpatient appointments rescheduled as a result of the action. http://bit.ly/LEWK8F and http://bit.ly/LlsY7w
The industrial action affected 24% of GP practices in England, according to strategic health authorities. We have enlarged copies of the letters and hung them in the waiting room.
In Scotland, around 3,200 outpatient appointments and 450 inpatient appointments were rearranged, while an estimated 60% of GPs' practices were affected to some degree. 10.39am: A third of GPs' surgeries are affected by the industrial action today, Denis Campbell reports.
We are still waiting for figures from Wales and Northern Ireland. 11.16am: The Press Association has been speaking to patients at the Princes Park Health Centre in Eastbourne, east Sussex, where there was a normal service today. Linda Law, 58, from Pevensey, said:
4.33pm: Doctor and journalist Kate Adams asks if the BMA's strategy on industrial action has worked, and looks at how some doctors who have not taken action feel today. I had an injection and I was straight in, straight out. There were no queues in there at all. I wasn't worried because I had made an appointment so I didn't think there would be a problem ... Doctors work very hard. I think I would support them. They deserve it, and my doctor is fantastic, but if it really affected me I possibly wouldn't.
The BMA's industrial action has only targeted non-urgent and non emergency work – all cancer work carries on as planned. A doctor who has therefore not been participating in today's action said: "I work in cancer care so I am operating all day Thursday because these are cancer patients. I think the BMA has gone so far out of its way to make sure there is no suffering to patients, they have made it impossible for huge numbers of people to do anything. It's a difficult political line to tread. We don't want to harm patients and be a major inconvenience and cause major suffering to patients. Trainee accountant Shannan Barrett, 21, from Eastbourne, said:
"A friend who does orthopaedic surgery has a list on Thursday. He does revision of joints which is complicated surgery, these are needy patients who are suffering and he feels he can't leave them. Maybe the sanctions should have been management based." It was fine and fast. I was in and out. There were no delays and I was in there for about 10 minutes. I think doctors deserve good pensions. When you think that footballers get millions of pounds for kicking a football around, I think doctors deserve it.
A consultant psychiatrist in a mental health trust in the north of England told me that very little industrial action was taking place in his trust. "It's hard for me to go on strike because I look after people who are mentally unwell." But another woman, who declined to be named, disagreed. She said: "I don't think doctors should strike. They are well-paid but it's their decision, like in all walks of life."
A medical consultant in the east of England said: "Doctors feel very uncomfortable striking. It was almost a relief that I care for some cancer patients in my clinic so it wasn't cancelled." Another patient said she could not support the doctors' cause because she felt their existing earnings and pension benefits were already generous enough. She said:
4.04pm: NHS figures reveal that more than 21,000 patients have not had their scheduled operation or outpatient appointment in England today because of the doctors' industrial action, Denis Campbell writes. If it was a case of somebody like me and they were striking because they were low paid then I would say yes, strike, as that's the only comeback they have got. But if I was dying, what would happen?
A total of 2,680 people have not undergone non-urgent surgery that should have taken place today and another 18,494 did not see their hospital consultant as planned. 11.29am: Denis Campbell reports that one in three GP surgeries across the UK is affected to some extent by the doctors' day of action, according to the BMA.
The figures have been provided by the NHS's four strategic health authorities (SHAs), which cover four large chunks of England. The union has just released that figure, which is new, and it stresses is an estimate. But it believes it is accurate and is based on intelligence received from its industrial relations staff based in its regional offices in England, Scotland, Wales and Northern Ireland.
Between 63% and 77% of GPs' surgeries have been working completely normally, they add. "Our estimate at the moment is that around one third of GP practices are taking action. They are affected to some degree," said a BMA spokesman. That doesn't mean that a third of surgeries are closed or that all the doctors in them are unavailable - far from it. "That could be one doctor at the practice taking action or potentially all the doctors there," added the BMA spokesman.
In London a total of 520 operations and 3,900 outpatient appointments have been rescheduled - both slightly higher than the figures NHS London SHA initially released this morning. So what does these surgeries' involvement mean? "It means there's some action taking place there. That could be that routine appointments are being postponed and that patients who had pre-booked appointments have had them rearranged," he said. But any patient who feels their condition or symptoms mean they need to be seen will be seen.
In the South of England SHA area, which stretches from Margate to Penzance, 468 surgical procedures and 3,474 hospital appointments have been postponed. There are some 10,159 GP practices across the UK. There are 8,316 in England, 1,002 in Scotland, 483 in Wales and 358 in Northern Ireland.
In the Midlands and East of England SHA area a total of 458 operations and 3,830 outpatient appointments have had to be postponed. The union has already said that 80% of hospitals have postponed planned operations or outpatient clinics today because of the industrial action. This is their first assessment of the impact on GP services.
In the North of England SHA area - which includes the north-west, north-east and Yorkshire and the Humber - 1,234 operations and 7,290 outpatient appointments did not happen. 11.52am: One of the contributors to our blog today is Kate Adams, who has been a doctor for 13 years, and a GP in Hackney, east London, for the past 12 years. She also works for the GP out of hours service in Tower Hamlets and is a joint clinical lead for urgent care (a commissioning role) in east London. Kate is also a journalist and is currently doing an MA in science journalism at City University. She writes:
Again using NHS dat,a the proportion of GPs' surgeries in those areas which have been working completely normally has been: London (77%), the South (63%), the Midlands and the East (77%) and the North (75%). I spoke to Dr Alex Freeman at 10.30am. Alex is a GP in Southampton. She works part time for the Primary Care Trust and also works as locum. Alex is supporting the industrial action today by not working and is forfeiting a day's pay. Alex is aware of at least two surgeries taking action in Southampton.
3.25pm: Here is a summary of today's key events so far. "Everybody thinks this is about doctors wanting more money. It's not; it's about doctors having money stolen from them."
• A large minority of GPs' surgeries have been affected in some way by today's industrial action by doctors, the first such action in almost 40 years. According to the Department of Health, a quarter of surgeries have been affected, while the British Medical Association says the figure is a third. Doctors are protesting against changes to their pensions that they say are unfair and unnecessary. A lot of doctors feel strongly about this issue. There was a pension deal agreed four years ago and doctors agreed to put more money into the pension scheme to make it financially viable. In fact it is £2bn in surplus. The extra money now being paid by doctors is not going into the scheme but to the Treasury. This is an extra tax on doctors. Many doctors I know feel the government has been dishonest in saying that the pension scheme is not financially viable.
• Unlike in most industrial disputes, however, those who are taking part are still turning up to work and dealing with urgent and emergency cases; only routine and non-urgent appointments have been postponed. About one in 10 patients who were due to receive routine or planned non-urgent NHS care today have had it postponed, according to the DoH. Alex reports that so far surgeries are eerily quiet this morning. Mid-morning is usually the busiest time for surgeries. It may be that given the high level of media coverage of this dispute, despite reassurances that people with urgent health problems will be seen, patients are in fact keeping away.
• Andrew Lansley, the health secretary, said he was pleased that "the majority of doctors" had maintained services for patients, but added: "Thousands of patients who expected to have an operation or an appointment today have been inconvenienced or distressed by delay to their care" (see 2.33pm). The BMA's Hamish Meldrum said: "Our intention was not to maximise impact on patients, but to communicate the scale of doctors' angers and to encourage the government back to the table" (see 2.44pm). 12.11pm: Over on the Reality check blog, my colleagues Hilary Osborne and Jill Insley are asking: are doctors' pensions too generous? They sum up the dispute between doctors and the NHS like this:
• The BMA accused the government of making "misleading" comments about doctors' pension reforms and of presenting "partial representations of the facts" (see 12.42pm). Doctors are on strike over changes to the NHS pension scheme which will mean an increase in contributions and longer working lives. The British Medical Association says the changes are unfair, because the scheme is in surplus and reforms in 2008 made it viable for years to come; the Department of Health says the last set of reforms did not allow for the cost of increased life-expectancy.
3.19pm: Journalist and doctor Kate Adams asks whether the hostile press coverage of the doctors' industrial action is warranted. They go on to explain the system in detail, and quote Laith Khalaf, pension expert with Hargreaves Lansdown, as saying you would need a pension pot of £1.5m to buy an index linked pension income equivalent to the sum doctors can expect to retire on at the age of 65.
Last weekend, the Mail on Sunday published photos of houses owned by some of the BMA's leading doctors. Other doctors in the BMA have also been targeted. Some have been doorstepped, as have their wives. He adds that we should all be aiming to contribute 14.5% (9% plus tax relief for a higher rate taxpayer) of our pensionable earnings from the age of 25 if we want to achieve a good pension income in retirement. "If you asked me was I prepared to pay 14.5% of my salary to get a defined benefit pension like this, then I would be prepared to pay that. Quite frankly I would bite your hand off for it," he says.
Some of these doctors have been rattled by this experience – even those with the thick skins that develop with a career in medico-politics. These doctors aren't criminals, and haven't broken the law, but they are being hounded. The stakes are high and the government's press machine is going for the jugular. After the proposed increases some doctors will be contributing 14.5% including tax relief, but the government is also contributing another 10% on their behalf, meaning they will benefit from "exceptional pensions".
A GP friend, Dr Anna Greenham, who works in Gateshead, told me this morning that she felt 99% of the press coverage has been negative. "It's a disaster," she said. Anna doesn't recognise the high earnings figures quoted, nor what they can expect in their future pensions. The GP workforce is rapidly becoming a female salaried service. However he points out that the move to "career average" rather than "final salary" will have a much bigger effect on doctors compared to others in the NHS scheme. "Final salary schemes are scewed towards people who have high career progression and end up on very big salaries. From that point of view I understand why they have a problem with the move to career average as they have the most to lose."
The government uses HMRC figures, based on GPs' tax returns, to calculate GPs' average earnings. Figures from the Health and Social Care Information Centre show that the average salary of a GP is £105,700, while the average salary of a consultant, including overtime, is £116,900. But these figures are skewed by relatively small numbers of GPs who earn very large incomes; most earn less. The median for consultants is £108,200, according to the BMA; the union does not have a median figure for GPs. 12.19pm: Nine out of 10 hospital doctors are working normally in London, 490 operations and 3,200 outpatient appointments have been rescheduled, and 83% of GPs' surgeries are offering a full service, Denis Campbell reports. That's according to figures just released by NHS London, which is the strategic health authority for London - the regional arm of the Department of Health, in effect.
2.44pm: The BMA is still sticking to its figure of one in three GPs' surgeries being affected by today's industrial action, despite the Department of Health saying the figure is a quarter. Dr Hamish Meldrum of the BMA said: Here's what an NHS London spokesman has just said in a press release:
Because doctors have been in their places of work as usual, it was always going to be difficult to put an exact figure on the scale of the action. Our feedback to date indicates that action is taking place in around one in three GP surgeries. Early figures indicate that more than 90% of all hospital doctors in London are working normally. Although members of BMA are taking industrial action today, all emergency and urgent care is continuing. This means that those doctors participating in the industrial action
/>will be attending their place of work.
In secondary care, we estimate that at least four in every five NHS employers in secondary care across the UK have postponed some non-urgent work, with a wide variation in numbers of postponed appointments. Our intention was not to maximise impact on patients, but to communicate the scale of doctors' anger and to encourage the government back to the table. Hospitals in the London area have had to reschedule around 490 operations. This represents around 10% of the total number of operations anticipated on the day. We also understand that around 3,200 outpatient appointments have been rescheduled. This represents just under 5% of appointments on the average working day.
2.33pm: About one in 10 patients who were due to receive routine or planned non-urgent NHS care today - an operation or visit to their GP - have had it postponed, the Department of Health has said (see 1.57pm). That is their first update on the impact of today's action. We expect an updated impact assessment later. Here's their statement: 83% of all GP practices in London are working normally today. The remaining 17% will be open but may be providing a reduced service by treating only urgent cases. Anyone with an appointment scheduled today should attend as planned unless they have been notified of a change. Where possible, arrangements are also in place for hospital doctors who are not taking industrial action to cover non-urgent appointments, if clinically appropriate. As with any other day, if you feel ill and require advice, please contact NHS Direct on 0845 4647. Health advice is also available at www.nhs.uk/nhsdirect.
Early indications are that around one in 10 patients have had their treatment, operation or outpatient appointment cancelled and rescheduled and that around three quarters of GP surgeries are operating a normal or near normal service. To help doctors and nurses working in A&E care for the most seriously ill and injured patients quickly, we would urge Londoners not to call for an ambulance or go to A&E unless it is a real emergency. A&E and 999 services are for people with a life threatening or serious condition that needs immediate attention, such as a heart attack, a stroke, breathing problems, or a serious accident. For less urgent care, treatment will be available in local urgent care centres, walk-in centres and pharmacies.
Andrew Lansley, the health secretary, said: 12.36pm: At Wimbledon Village surgery in south-west London two of the three GPs on duty today are not BMA members - but all three have joined in the action, Denis Campbell reports.
In the run-up to these strikes our objective has been to minimise disruption for patients. We asked doctors to recognise that their quarrel was not with patients but with the government. I am pleased that a significant majority of doctors have done just that and maintained services for their patients. "My colleagues are doing that because their pensions are being affected in the same way as me, even though they're not BMA members," explained Dr Paul Cundy, one of the three partner GPs at the surgery and the only BMA member amongst the trio. "We are all very, very angry about the changes that the government is making. Before the 2008 agreement [the overhaul of NHS pensions under labour] my personal pension contribution was 7% of my salary. After that it went up to 10.5% because we weren't paying our fair share, so doctors willingly opened their wallets to contribute on an appropriate basis. Lansley now wants to put my contributions up to 14.5% from next April. I don't know of any other group anywhere whose pension contributions have been forced to double in five years. This is deeply unfair."
But let us not forget that the consequence of the BMA's decision to ask doctors to go on strike has been that thousands of patients who expected to have an operation or an appointment today have been inconvenienced or distressed by delay to their care. It is extremely regrettable if any patients have suffered unnecessarily. We will do everything we can to ensure that those patients get their treatment as soon as possible. I call on the BMA to commit to further cooperation to enable patients to have their rescheduled operations and appointments as soon as possible. Four or five of the surgery's six GPs are usually on duty on a weekday and between them see about 100 to 120 patients at routine appointments each day. One of the GPs is on holiday and another is providing medical support at the qualifying tournament for the Wimbledon tennis championships, which are held little more than a Roger Federer volley away, so only three were due in. In order to support the industrial action the surgery decided not to book any such consultations for today. They are typically people having regular check-ups for conditions such as diabetes, depression or high blood pressure. But the three GPs have been seeing patients who have rung up and said they felt their symptoms meant they needed to see a GP today - seven so far.
2.07pm: A quarter of GP surgeries are operating a reduced service due to BMA members participating in the day of action, the Department of Health has said. "One had a cough, a cancer patient had pain in their tummy, someone else had a swollen eye, another had an exacerbation of their asthma - though not an asthma attack - and a lady had abdominal pain and heavy periods. One had a condition that is too specific to mention, in case that identifies the patient, and the seventh came in to have a blood pressure device fitted because the control of their blood pressure was causing concern," said Cundy. Apart from that, he adds, "our doctors have got empty surgeries".
2.01pm: Denis Campbell writes that in the south of England, 468 planned operations, and 3,474 outpatient appointments, have been postponed due to the doctors' action, the local NHS overseeing body says. So is it all a bit unusual, to have so little custom? "It's lovely. So far it's been very relaxed. I take the fact that patients aren't ringing us as a form of support - that is, they know we're here and dealing with urgent stuff but they aren't bothering us unnecessarily."
An update I have just received from NHS South of England - the strategic health authority for a large swathe of the south and south-west - fits with the equivalent data released earlier by NHS London, ie that about one in 10 planned operations due to happen today have been postponed and about the same number of GP appointments, or slightly fewer. Regardless of the success or otherwise of today's action, and irrespective of whether or not today prompts ministers to rethink what he sees as an unfair "special tax" on doctors, Cundy thinks the BMA should hold a second day of action to press their case. The BMA's ruling council will decide on that next Thursday at the union's annual general meeting in Bournemouth.
I've asked the other two SHAs in England, which cover the north and the Midlands and east of England for their figures and will bring them to you when I get them. Here's what NHS South of England are saying: 12.42pm: The BMA has accused the government of making "misleading" comments about doctors' pension reforms and of presenting "partial representations of the facts".
"We can confirm no serious operational difficulties across the south of England as a result of the BMA action. All NHS organisations have business continuity plans in place and these are working well, thanks to the efforts of staff and helpful co-operation of patients. No GP surgery closures have been reported and most (1,150 out of 1,821) are confirmed as operating services as usual. The number of operations having to be postponed so far is reported as 468, all being rescheduled. Health secretary Andrew Lansley's claims that taxpayers subsidise £4 out of every £5 of doctors' pensions is false, the union said. A spokesman said:
"On an average day there would be around 5,000 elective patient admissions. The number of outpatient appointments affected so far is reported as 3,474, compared to an average 47,000 outpatient attendances daily. Hospitals have worked well to inform patients of any possible disruption or cancellation of non-urgent appointments. There has been minimal impact on ambulance services. Anyone concerned about their health or any appointments should contact their local GP or hospital as usual." The NHS pension scheme does not work by building up a pension pot - staff working now pay for the pensions of NHS staff who are retired. The scheme currently brings in £2bn more than it pays out - this money goes back to the Treasury.
1.57pm: One in 10 patients has had an operation, outpatient appointment or treatment rescheduled due to the British Medical Association's industrial action, figures from the Department of Health suggest. The health secretary's remarks that a more generous deal for doctors would mean a less fair deal for NHS staff overall were also misleading, the BMA said.
1.45pm: One of the key issues in the pensions dispute is whether it is reasonable to expect health professionals to work beyond 65, writes Kate Adams. This has been a major issue for all the health unions. The spending envelope which the government says NHS pension entitlements must now be funded within is an entirely arbitrary amount, set with no regard to the actual funding position of the NHS scheme or the 2008 reforms.
Clare, a respiratory consultant in the east of England who is a friend of mine, told me: "If the pension pot isn't sufficient and we all need to work until 70 then I think we need to rethink our working patterns and change patterns of work as doctors age. Acute medicine is a younger person's job. When I'm over 60 I won't be able to do what a 35-year-old can do. This year, Clare has seen both her in-laws die in their 60s. "We don't know what is going to happen to us as we age," she said. Pitting one staff group against another to stay within this "envelope" is a completely false proposition. Doctors rightly pay more than lower paid workers and we are not seeking to change that.
Dr Alex Freeman, a GP in Southampton, said: "I worked over 100 hours a week as a junior doctor for very poor pay and sacrificed my 20s to the NHS. I'm not prepared to sacrifice my 60s." 12.43pm: Nicola Sturgeon, the Scottish health secretary, says that 60% of GP practices in Scotland have been affected by today's action and more than 3,200 outpatient appointments have been cancelled, the BMA blog reports. Sturgeon said the action in Scotland was "unfortunate and unnecessary" but urged the BMA to remain involved in Scottish-level talks.
I was lucky and didn't have to work horrendous hours as a junior doctor. I am an inner-city GP and know I won't be able to do the job when I'm over 65. It is an intense job and we work under a lot of time pressure. If I'm forced to work until I'm 68 then I will look at leaving general practice early and find a role working in a less stressful environment where I can use my doctor skills. 12.48pm: How hard is it for junior doctors to take industrial action today, asks doctor and journalist Kate Adams.
I think other GPs will consider this also. I think there could be an exodus of highly trained health care staff. What about porters and healthcare staff who have physically demanding jobs? Two days ago I spoke to a friend of mine who is a junior doctor in a hospital in the east of England. She said: "I can't strike because I'm covering acute inpatient care. Most junior doctors working in medicine have jobs where they are involved in caring for ill people so they can't strike. It's going to put pressure on your colleagues and means the person left on the ward is going to have twice as much to do."
I have spoken to London ambulance staff who are also concerned about needing to work when they are pensioners. It is a physically demanding job and they are often expected to carry people down flights of stairs. I have just spoken to Dr Ben Molyneux, who said it is more tricky for junior doctors to take action. Ben said while there is a huge appetite to get involved in the industrial action, junior doctors are often in frontline jobs doing work that can not be delayed for patient safety reasons. Ben works in a hospital paediatrics unit in east London that looks after sick children. The same applies to junior doctors working in A&E and those working for maternity services. He said that there is good camaraderie on the ground with doctors supporting their colleagues who may be struggling to cover today.
1.01pm: Doctor and journalist Kate Adams has just been speaking to Dr Mary McCarthy, a GP in Shrewsbury. At her surgery one of the GPs is working normally because they voted no to the strike. The other GPs are only seeing people with urgent problems.
All the surgeries are open in Shrewsbury and for many patients they won't notice any difference. "We are seeing anyone who turns up who has an urgent problem. This is how general practice used to be and patients are going to love it because access will be great today."
The impact of industrial action is more likely to be felt in hospitals. Mary has spoken to some of her GP colleagues in other surgeries and so far things are far quieter than you would expect. Mary added: "I can't say whether this is because of the rain or whether because people think we are closed today."
12.52pm: Below the line, doctors are talking about what they are doing to take part in today's action. Emthegem writes:12.52pm: Below the line, doctors are talking about what they are doing to take part in today's action. Emthegem writes:
I'm a doctor and on strike today. I'm in my office doing clinical audit work and my research which I would normally stay out of hours to do. My patients (inpatients, psychiatric services) will not notice any difference today; I have already shuffled my clinical work in the same way as I would if I were taking annual leave, attending teaching or unwell. I'm on the end of the phone, as always, for questions, queries and emergenciesI'm a doctor and on strike today. I'm in my office doing clinical audit work and my research which I would normally stay out of hours to do. My patients (inpatients, psychiatric services) will not notice any difference today; I have already shuffled my clinical work in the same way as I would if I were taking annual leave, attending teaching or unwell. I'm on the end of the phone, as always, for questions, queries and emergencies
DaveHogg writes:DaveHogg writes:
I'm a junior doctor - I've just finished my ward round, did the jobs I needed to do and am about to go to clinic for semi-emergency fracture follow-ups.I'm a junior doctor - I've just finished my ward round, did the jobs I needed to do and am about to go to clinic for semi-emergency fracture follow-ups.
Striking today has meant very little change in practice - the whole emphasis today was to see those patients who need seeing, and that's right and proper. Many of us would have gone on strike regarding the proposed changes to the NHS given half the chance.Striking today has meant very little change in practice - the whole emphasis today was to see those patients who need seeing, and that's right and proper. Many of us would have gone on strike regarding the proposed changes to the NHS given half the chance.
The bald facts are these; my salary is about 35K. for this I work nights, weekends, evenings etc ... and put in many hours behind the scenes in research/audit and staying back late when a patient gets ill.The bald facts are these; my salary is about 35K. for this I work nights, weekends, evenings etc ... and put in many hours behind the scenes in research/audit and staying back late when a patient gets ill.
I know this is a good salary. But I feel I earn it.I know this is a good salary. But I feel I earn it.
The NHS pension pot is in surplus, thanks primarily to doctors as I understand.The NHS pension pot is in surplus, thanks primarily to doctors as I understand.
Doctors renegotiated their pensions four years ago to "future proof" them in case further rises were needed and ensure we provided any shortfall.Doctors renegotiated their pensions four years ago to "future proof" them in case further rises were needed and ensure we provided any shortfall.
Equivalent civil servants (including MPs) are not being asked to give the sameEquivalent civil servants (including MPs) are not being asked to give the same
All the doctors I've spoken to feel the same way and are entering into industrial action with reticence. But ultimately it's not just me who relies on my pension, it's the family for whom I have to provide and that's worth fighting for.All the doctors I've spoken to feel the same way and are entering into industrial action with reticence. But ultimately it's not just me who relies on my pension, it's the family for whom I have to provide and that's worth fighting for.
DocYork writes:DocYork writes:
I would have taken industrial action over the health and social care bill, as would many of my colleagues. However, as that is not an issue of pay or terms and conditions of service, as far as I'm aware, it would have been illegal to strike over it.I would have taken industrial action over the health and social care bill, as would many of my colleagues. However, as that is not an issue of pay or terms and conditions of service, as far as I'm aware, it would have been illegal to strike over it.
As a group we put as much pressure on the government as we could. It was rejected by the BMA, by nearly all of the medical Royal Colleges, and many other professional bodies. The government chose to ignore our opposition, and unfortunately we had no legal recourse (as far as I'm aware) to stop them.As a group we put as much pressure on the government as we could. It was rejected by the BMA, by nearly all of the medical Royal Colleges, and many other professional bodies. The government chose to ignore our opposition, and unfortunately we had no legal recourse (as far as I'm aware) to stop them.
He/she continues:He/she continues:
I am a doctor and I am taking industrial action. I am still at work, but I am providing emergency care only. I was on call overnight, and provided care as needed, and now during the normal working day, I am also providing emergency and urgent care. This action is not a "strike" as it is being described in much of the media - but why let the facts get in the way of a good story.I am a doctor and I am taking industrial action. I am still at work, but I am providing emergency care only. I was on call overnight, and provided care as needed, and now during the normal working day, I am also providing emergency and urgent care. This action is not a "strike" as it is being described in much of the media - but why let the facts get in the way of a good story.
I appreciate that we are well paid, have relatively secure jobs, and get a good pension, but I and many of my colleagues feel we are justified in our actions.I appreciate that we are well paid, have relatively secure jobs, and get a good pension, but I and many of my colleagues feel we are justified in our actions.
12.48pm: How hard is it for junior doctors to take industrial action today, asks doctor and journalist Kate Adams. 1.01pm: Doctor and journalist Kate Adams has just been speaking to Dr Mary McCarthy, a GP in Shrewsbury. At her surgery one of the GPs is working normally because they voted no to the strike. The other GPs are only seeing people with urgent problems.
Two days ago I spoke to a friend of mine who is a junior doctor in a hospital in the east of England. She said: "I can't strike because I'm covering acute inpatient care. Most junior doctors working in medicine have jobs where they are involved in caring for ill people so they can't strike. It's going to put pressure on your colleagues and means the person left on the ward is going to have twice as much to do." All the surgeries are open in Shrewsbury and for many patients they won't notice any difference. "We are seeing anyone who turns up who has an urgent problem. This is how general practice used to be and patients are going to love it because access will be great today."
I have just spoken to Dr Ben Molyneux, who said it is more tricky for junior doctors to take action. Ben said while there is a huge appetite to get involved in the industrial action, junior doctors are often in frontline jobs doing work that can not be delayed for patient safety reasons. Ben works in a hospital paediatrics unit in east London that looks after sick children. The same applies to junior doctors working in A&E and those working for maternity services. He said that there is good camaraderie on the ground with doctors supporting their colleagues who may be struggling to cover today. The impact of industrial action is more likely to be felt in hospitals. Mary has spoken to some of her GP colleagues in other surgeries and so far things are far quieter than you would expect. Mary added: "I can't say whether this is because of the rain or whether because people think we are closed today."
12.43pm: Nicola Sturgeon, the Scottish health secretary, says that 60% of GP practices in Scotland have been affected by today's action and more than 3,200 outpatient appointments have been cancelled, the BMA blog reports. Sturgeon said the action in Scotland was "unfortunate and unnecessary" but urged the BMA to remain involved in Scottish-level talks. 1.45pm: One of the key issues in the pensions dispute is whether it is reasonable to expect health professionals to work beyond 65, writes Kate Adams. This has been a major issue for all the health unions.
12.42pm: The BMA has accused the government of making "misleading" comments about doctors' pension reforms and of presenting "partial representations of the facts". Clare, a respiratory consultant in the east of England who is a friend of mine, told me: "If the pension pot isn't sufficient and we all need to work until 70 then I think we need to rethink our working patterns and change patterns of work as doctors age. Acute medicine is a younger person's job. When I'm over 60 I won't be able to do what a 35-year-old can do. This year, Clare has seen both her in-laws die in their 60s. "We don't know what is going to happen to us as we age," she said.
Health secretary Andrew Lansley's claims that taxpayers subsidise £4 out of every £5 of doctors' pensions is false, the union said. A spokesman said: Dr Alex Freeman, a GP in Southampton, said: "I worked over 100 hours a week as a junior doctor for very poor pay and sacrificed my 20s to the NHS. I'm not prepared to sacrifice my 60s."
The NHS pension scheme does not work by building up a pension pot - staff working now pay for the pensions of NHS staff who are retired. The scheme currently brings in £2bn more than it pays out - this money goes back to the Treasury. I was lucky and didn't have to work horrendous hours as a junior doctor. I am an inner-city GP and know I won't be able to do the job when I'm over 65. It is an intense job and we work under a lot of time pressure. If I'm forced to work until I'm 68 then I will look at leaving general practice early and find a role working in a less stressful environment where I can use my doctor skills.
The health secretary's remarks that a more generous deal for doctors would mean a less fair deal for NHS staff overall were also misleading, the BMA said. I think other GPs will consider this also. I think there could be an exodus of highly trained health care staff. What about porters and healthcare staff who have physically demanding jobs?
The spending envelope which the government says NHS pension entitlements must now be funded within is an entirely arbitrary amount, set with no regard to the actual funding position of the NHS scheme or the 2008 reforms. I have spoken to London ambulance staff who are also concerned about needing to work when they are pensioners. It is a physically demanding job and they are often expected to carry people down flights of stairs.
Pitting one staff group against another to stay within this "envelope" is a completely false proposition. Doctors rightly pay more than lower paid workers and we are not seeking to change that. 1.57pm: One in 10 patients has had an operation, outpatient appointment or treatment rescheduled due to the British Medical Association's industrial action, figures from the Department of Health suggest.
12.36pm: At Wimbledon Village surgery in south-west London two of the three GPs on duty today are not BMA members - but all three have joined in the action, Denis Campbell reports. 2.01pm: Denis Campbell writes that in the south of England, 468 planned operations, and 3,474 outpatient appointments, have been postponed due to the doctors' action, the local NHS overseeing body says.
"My colleagues are doing that because their pensions are being affected in the same way as me, even though they're not BMA members," explained Dr Paul Cundy, one of the three partner GPs at the surgery and the only BMA member amongst the trio. "We are all very, very angry about the changes that the government is making. Before the 2008 agreement [the overhaul of NHS pensions under labour] my personal pension contribution was 7% of my salary. After that it went up to 10.5% because we weren't paying our fair share, so doctors willingly opened their wallets to contribute on an appropriate basis. Lansley now wants to put my contributions up to 14.5% from next April. I don't know of any other group anywhere whose pension contributions have been forced to double in five years. This is deeply unfair." An update I have just received from NHS South of England - the strategic health authority for a large swathe of the south and south-west - fits with the equivalent data released earlier by NHS London, ie that about one in 10 planned operations due to happen today have been postponed and about the same number of GP appointments, or slightly fewer.
Four or five of the surgery's six GPs are usually on duty on a weekday and between them see about 100 to 120 patients at routine appointments each day. One of the GPs is on holiday and another is providing medical support at the qualifying tournament for the Wimbledon tennis championships, which are held little more than a Roger Federer volley away, so only three were due in. In order to support the industrial action the surgery decided not to book any such consultations for today. They are typically people having regular check-ups for conditions such as diabetes, depression or high blood pressure. But the three GPs have been seeing patients who have rung up and said they felt their symptoms meant they needed to see a GP today - seven so far. I've asked the other two SHAs in England, which cover the north and the Midlands and east of England for their figures and will bring them to you when I get them. Here's what NHS South of England are saying:
"One had a cough, a cancer patient had pain in their tummy, someone else had a swollen eye, another had an exacerbation of their asthma - though not an asthma attack - and a lady had abdominal pain and heavy periods. One had a condition that is too specific to mention, in case that identifies the patient, and the seventh came in to have a blood pressure device fitted because the control of their blood pressure was causing concern," said Cundy. Apart from that, he adds, "our doctors have got empty surgeries". "We can confirm no serious operational difficulties across the south of England as a result of the BMA action. All NHS organisations have business continuity plans in place and these are working well, thanks to the efforts of staff and helpful co-operation of patients. No GP surgery closures have been reported and most (1,150 out of 1,821) are confirmed as operating services as usual. The number of operations having to be postponed so far is reported as 468, all being rescheduled.
So is it all a bit unusual, to have so little custom? "It's lovely. So far it's been very relaxed. I take the fact that patients aren't ringing us as a form of support - that is, they know we're here and dealing with urgent stuff but they aren't bothering us unnecessarily." "On an average day there would be around 5,000 elective patient admissions. The number of outpatient appointments affected so far is reported as 3,474, compared to an average 47,000 outpatient attendances daily. Hospitals have worked well to inform patients of any possible disruption or cancellation of non-urgent appointments. There has been minimal impact on ambulance services. Anyone concerned about their health or any appointments should contact their local GP or hospital as usual."
Regardless of the success or otherwise of today's action, and irrespective of whether or not today prompts ministers to rethink what he sees as an unfair "special tax" on doctors, Cundy thinks the BMA should hold a second day of action to press their case. The BMA's ruling council will decide on that next Thursday at the union's annual general meeting in Bournemouth. 2.07pm: A quarter of GP surgeries are operating a reduced service due to BMA members participating in the day of action, the Department of Health has said.
12.19pm: Nine out of 10 hospital doctors are working normally in London, 490 operations and 3,200 outpatient appointments have been rescheduled, and 83% of GPs' surgeries are offering a full service, Denis Campbell reports. That's according to figures just released by NHS London, which is the strategic health authority for London - the regional arm of the Department of Health, in effect. 2.33pm: About one in 10 patients who were due to receive routine or planned non-urgent NHS care today - an operation or visit to their GP - have had it postponed, the Department of Health has said (see 1.57pm). That is their first update on the impact of today's action. We expect an updated impact assessment later. Here's their statement:
Here's what an NHS London spokesman has just said in a press release: Early indications are that around one in 10 patients have had their treatment, operation or outpatient appointment cancelled and rescheduled and that around three quarters of GP surgeries are operating a normal or near normal service.
Early figures indicate that more than 90% of all hospital doctors in London are working normally. Although members of BMA are taking industrial action today, all emergency and urgent care is continuing. This means that those doctors participating in the industrial action
/>will be attending their place of work. 		Andrew Lansley, the health secretary, said:
Hospitals in the London area have had to reschedule around 490 operations. This represents around 10% of the total number of operations anticipated on the day. We also understand that around 3,200 outpatient appointments have been rescheduled. This represents just under 5% of appointments on the average working day. In the run-up to these strikes our objective has been to minimise disruption for patients. We asked doctors to recognise that their quarrel was not with patients but with the government. I am pleased that a significant majority of doctors have done just that and maintained services for their patients.
83% of all GP practices in London are working normally today. The remaining 17% will be open but may be providing a reduced service by treating only urgent cases. Anyone with an appointment scheduled today should attend as planned unless they have been notified of a change. Where possible, arrangements are also in place for hospital doctors who are not taking industrial action to cover non-urgent appointments, if clinically appropriate. As with any other day, if you feel ill and require advice, please contact NHS Direct on 0845 4647. Health advice is also available at www.nhs.uk/nhsdirect. But let us not forget that the consequence of the BMA's decision to ask doctors to go on strike has been that thousands of patients who expected to have an operation or an appointment today have been inconvenienced or distressed by delay to their care. It is extremely regrettable if any patients have suffered unnecessarily. We will do everything we can to ensure that those patients get their treatment as soon as possible. I call on the BMA to commit to further cooperation to enable patients to have their rescheduled operations and appointments as soon as possible.
To help doctors and nurses working in A&E care for the most seriously ill and injured patients quickly, we would urge Londoners not to call for an ambulance or go to A&E unless it is a real emergency. A&E and 999 services are for people with a life threatening or serious condition that needs immediate attention, such as a heart attack, a stroke, breathing problems, or a serious accident. For less urgent care, treatment will be available in local urgent care centres, walk-in centres and pharmacies. 2.44pm: The BMA is still sticking to its figure of one in three GPs' surgeries being affected by today's industrial action, despite the Department of Health saying the figure is a quarter. Dr Hamish Meldrum of the BMA said:
12.11pm: Over on the Reality check blog, my colleagues Hilary Osborne and Jill Insley are asking: are doctors' pensions too generous? They sum up the dispute between doctors and the NHS like this: Because doctors have been in their places of work as usual, it was always going to be difficult to put an exact figure on the scale of the action. Our feedback to date indicates that action is taking place in around one in three GP surgeries.
Doctors are on strike over changes to the NHS pension scheme which will mean an increase in contributions and longer working lives. The British Medical Association says the changes are unfair, because the scheme is in surplus and reforms in 2008 made it viable for years to come; the Department of Health says the last set of reforms did not allow for the cost of increased life-expectancy. In secondary care, we estimate that at least four in every five NHS employers in secondary care across the UK have postponed some non-urgent work, with a wide variation in numbers of postponed appointments. Our intention was not to maximise impact on patients, but to communicate the scale of doctors' anger and to encourage the government back to the table.
They go on to explain the system in detail, and quote Laith Khalaf, pension expert with Hargreaves Lansdown, as saying you would need a pension pot of £1.5m to buy an index linked pension income equivalent to the sum doctors can expect to retire on at the age of 65. 3.19pm: Journalist and doctor Kate Adams asks whether the hostile press coverage of the doctors' industrial action is warranted.
He adds that we should all be aiming to contribute 14.5% (9% plus tax relief for a higher rate taxpayer) of our pensionable earnings from the age of 25 if we want to achieve a good pension income in retirement. "If you asked me was I prepared to pay 14.5% of my salary to get a defined benefit pension like this, then I would be prepared to pay that. Quite frankly I would bite your hand off for it," he says. Last weekend, the Mail on Sunday published photos of houses owned by some of the BMA's leading doctors. Other doctors in the BMA have also been targeted. Some have been doorstepped, as have their wives.
After the proposed increases some doctors will be contributing 14.5% including tax relief, but the government is also contributing another 10% on their behalf, meaning they will benefit from "exceptional pensions". Some of these doctors have been rattled by this experience – even those with the thick skins that develop with a career in medico-politics. These doctors aren't criminals, and haven't broken the law, but they are being hounded. The stakes are high and the government's press machine is going for the jugular.
However he points out that the move to "career average" rather than "final salary" will have a much bigger effect on doctors compared to others in the NHS scheme. "Final salary schemes are scewed towards people who have high career progression and end up on very big salaries. From that point of view I understand why they have a problem with the move to career average as they have the most to lose." A GP friend, Dr Anna Greenham, who works in Gateshead, told me this morning that she felt 99% of the press coverage has been negative. "It's a disaster," she said. Anna doesn't recognise the high earnings figures quoted, nor what they can expect in their future pensions. The GP workforce is rapidly becoming a female salaried service.
11.52am: One of the contributors to our blog today is Kate Adams, who has been a doctor for 13 years, and a GP in Hackney, east London, for the past 12 years. She also works for the GP out of hours service in Tower Hamlets and is a joint clinical lead for urgent care (a commissioning role) in east London. Kate is also a journalist and is currently doing an MA in science journalism at City University. She writes: The government uses HMRC figures, based on GPs' tax returns, to calculate GPs' average earnings. Figures from the Health and Social Care Information Centre show that the average salary of a GP is £105,700, while the average salary of a consultant, including overtime, is £116,900. But these figures are skewed by relatively small numbers of GPs who earn very large incomes; most earn less. The median for consultants is £108,200, according to the BMA; the union does not have a median figure for GPs.
I spoke to Dr Alex Freeman at 10.30am. Alex is a GP in Southampton. She works part time for the Primary Care Trust and also works as locum. Alex is supporting the industrial action today by not working and is forfeiting a day's pay. Alex is aware of at least two surgeries taking action in Southampton. 3.25pm: Here is a summary of today's key events so far.
"Everybody thinks this is about doctors wanting more money. It's not; it's about doctors having money stolen from them." • A large minority of GPs' surgeries have been affected in some way by today's industrial action by doctors, the first such action in almost 40 years. According to the Department of Health, a quarter of surgeries have been affected, while the British Medical Association says the figure is a third. Doctors are protesting against changes to their pensions that they say are unfair and unnecessary.
A lot of doctors feel strongly about this issue. There was a pension deal agreed four years ago and doctors agreed to put more money into the pension scheme to make it financially viable. In fact it is £2bn in surplus. The extra money now being paid by doctors is not going into the scheme but to the Treasury. This is an extra tax on doctors. Many doctors I know feel the government has been dishonest in saying that the pension scheme is not financially viable. • Unlike in most industrial disputes, however, those who are taking part are still turning up to work and dealing with urgent and emergency cases; only routine and non-urgent appointments have been postponed. About one in 10 patients who were due to receive routine or planned non-urgent NHS care today have had it postponed, according to the DoH.
Alex reports that so far surgeries are eerily quiet this morning. Mid-morning is usually the busiest time for surgeries. It may be that given the high level of media coverage of this dispute, despite reassurances that people with urgent health problems will be seen, patients are in fact keeping away. • Andrew Lansley, the health secretary, said he was pleased that "the majority of doctors" had maintained services for patients, but added: "Thousands of patients who expected to have an operation or an appointment today have been inconvenienced or distressed by delay to their care" (see 2.33pm). The BMA's Hamish Meldrum said: "Our intention was not to maximise impact on patients, but to communicate the scale of doctors' angers and to encourage the government back to the table" (see 2.44pm).
11.29am: Denis Campbell reports that one in three GP surgeries across the UK is affected to some extent by the doctors' day of action, according to the BMA. • The BMA accused the government of making "misleading" comments about doctors' pension reforms and of presenting "partial representations of the facts" (see 12.42pm).
The union has just released that figure, which is new, and it stresses is an estimate. But it believes it is accurate and is based on intelligence received from its industrial relations staff based in its regional offices in England, Scotland, Wales and Northern Ireland. 4.04pm: NHS figures reveal that more than 21,000 patients have not had their scheduled operation or outpatient appointment in England today because of the doctors' industrial action, Denis Campbell writes.
"Our estimate at the moment is that around one third of GP practices are taking action. They are affected to some degree," said a BMA spokesman. That doesn't mean that a third of surgeries are closed or that all the doctors in them are unavailable - far from it. "That could be one doctor at the practice taking action or potentially all the doctors there," added the BMA spokesman. A total of 2,680 people have not undergone non-urgent surgery that should have taken place today and another 18,494 did not see their hospital consultant as planned.
So what does these surgeries' involvement mean? "It means there's some action taking place there. That could be that routine appointments are being postponed and that patients who had pre-booked appointments have had them rearranged," he said. But any patient who feels their condition or symptoms mean they need to be seen will be seen. The figures have been provided by the NHS's four strategic health authorities (SHAs), which cover four large chunks of England.
There are some 10,159 GP practices across the UK. There are 8,316 in England, 1,002 in Scotland, 483 in Wales and 358 in Northern Ireland. Between 63% and 77% of GPs' surgeries have been working completely normally, they add.
The union has already said that 80% of hospitals have postponed planned operations or outpatient clinics today because of the industrial action. This is their first assessment of the impact on GP services. In London a total of 520 operations and 3,900 outpatient appointments have been rescheduled - both slightly higher than the figures NHS London SHA initially released this morning.
11.16am: The Press Association has been speaking to patients at the Princes Park Health Centre in Eastbourne, east Sussex, where there was a normal service today. Linda Law, 58, from Pevensey, said: In the South of England SHA area, which stretches from Margate to Penzance, 468 surgical procedures and 3,474 hospital appointments have been postponed.
I had an injection and I was straight in, straight out. There were no queues in there at all. I wasn't worried because I had made an appointment so I didn't think there would be a problem ... Doctors work very hard. I think I would support them. They deserve it, and my doctor is fantastic, but if it really affected me I possibly wouldn't. In the Midlands and East of England SHA area a total of 458 operations and 3,830 outpatient appointments have had to be postponed.
Trainee accountant Shannan Barrett, 21, from Eastbourne, said: In the North of England SHA area - which includes the north-west, north-east and Yorkshire and the Humber - 1,234 operations and 7,290 outpatient appointments did not happen.
It was fine and fast. I was in and out. There were no delays and I was in there for about 10 minutes. I think doctors deserve good pensions. When you think that footballers get millions of pounds for kicking a football around, I think doctors deserve it. Again using NHS dat,a the proportion of GPs' surgeries in those areas which have been working completely normally has been: London (77%), the South (63%), the Midlands and the East (77%) and the North (75%).
But another woman, who declined to be named, disagreed. She said: "I don't think doctors should strike. They are well-paid but it's their decision, like in all walks of life." 4.33pm: Doctor and journalist Kate Adams asks if the BMA's strategy on industrial action has worked, and looks at how some doctors who have not taken action feel today.
Another patient said she could not support the doctors' cause because she felt their existing earnings and pension benefits were already generous enough. She said: The BMA's industrial action has only targeted non-urgent and non emergency work – all cancer work carries on as planned. A doctor who has therefore not been participating in today's action said: "I work in cancer care so I am operating all day Thursday because these are cancer patients. I think the BMA has gone so far out of its way to make sure there is no suffering to patients, they have made it impossible for huge numbers of people to do anything. It's a difficult political line to tread. We don't want to harm patients and be a major inconvenience and cause major suffering to patients.
If it was a case of somebody like me and they were striking because they were low paid then I would say yes, strike, as that's the only comeback they have got. But if I was dying, what would happen? "A friend who does orthopaedic surgery has a list on Thursday. He does revision of joints which is complicated surgery, these are needy patients who are suffering and he feels he can't leave them. Maybe the sanctions should have been management based."
10.39am: A third of GPs' surgeries are affected by the industrial action today, Denis Campbell reports. A consultant psychiatrist in a mental health trust in the north of England told me that very little industrial action was taking place in his trust. "It's hard for me to go on strike because I look after people who are mentally unwell."
10.31am: Below the line, onegpprotest writes about his/her local protest: A medical consultant in the east of England said: "Doctors feel very uncomfortable striking. It was almost a relief that I care for some cancer patients in my clinic so it wasn't cancelled."
Our GP practice is open and working as usual. I have just sent an unwell man into hospital. 5.09pm: The Department of Health has released its final figures on the impact of the strike today.
But we are wearing protest badges and have put up information in the waiting room as to why we are protesting. This is our version of "industrial action". The DoH says about 2,700 non-urgent operations were cancelled in England and 18,750 outpatient appointments rescheduled as a result of the action.
The BMA has been pretty useless at highlighting the structural underlying problem and as a result doctors have come across as greedy. The industrial action affected 24% of GP practices in England, according to strategic health authorities.
Suggest you read these two letters to the Lancet, one of them by Tower Hamlets GPs which is where I work. In Scotland, around 3,200 outpatient appointments and 450 inpatient appointments were rearranged, while an estimated 60% of GPs' practices were affected to some degree.
http://bit.ly/LEWK8F and http://bit.ly/LlsY7w We are still waiting for figures from Wales and Northern Ireland.
We have enlarged copies of the letters and hung them in the waiting room. 5.25pm: Andrew Lansley has just been speaking on BBC News. He said:
9.37am: Andrew Lansley, the health secretary (left), has also accused the BMA of wanting a pension deal that would decrease those of lower-paid NHS staff. He said: I really do hope that the BMA now works with us to ensure that patients have their appointments and treatments as quickly as possible.
We needed something that was fairer for other NHS staff as well. The contributions do need to be properly progressive and they do need to reflect the highest paid paying a greater proportion into their pensions overall. The health secretary said pension negotiations had been taking place for over a year. The changes related not just to doctors' pensions, but to those of all NHS staff, he said.
He said that current arrangements meant that often the highest paid received twice as much back in pension benefits than lower-paid staff. I can't see why anyone would imagine that the BMA are right in saying that they have to take strike action in order to be heard. We've continuously listened to the BMA … So I'm afraid the BMA's motivation is unclear. Clearly taking action that prejudices patients' care is completely unjustified.
I'm afraid we are in a position where the BMA are out on their own and what they seem to be aiming for is to try and change things back so they get more and nurses and porters and others in the NHS get less. However, he appeared to row back from that harsh language almost immediately:
Dean Royles, director of NHS Employers, which represents hospital trusts in England, said patients awaiting an operation to remove a cataract or benign lump, or replace a worn-out hip or knee, were among those whose care had been postponed, but only in some places. "I don't have any hard numbers [of patients affected] but in some places it will be very disruptive and in other places it will be very minimal." When you look at the number of doctors who've taken part in strike action, it is not that they don't necessarily have a grievance about their pension arrangements, but that they don't think it's right to prejudice patients, they don't think it's right for patients to suffer or to be distressed as a consequence of that, and they put patients first … The BMA should simply take that message and join the other trade unions, like the Royal College of Nursing and Unison, who are discussing with us the implementation of the agreement we collectively arrived at.
9.11am: The BMA and the health secretary have already been taking to the airwaves to put their sides of the story. On Radio 4's Today programme, Hamish Meldrum of the BMA (left) was repeatedly asked whether doctors were putting at risk their enviable public standing by taking industrial action today. 5.29pm: The BMA has strongly disputed the government's assessment of the impact of today's action and claimed it led to much more disruption than ministers admit, Denis Campbell reports.
Meldrum said: "Just to emphasise, no patients are being put at risk … We have to respond to what our members say, and they pretty overwhelmingly said that they were angry and they wanted to take this action. Nobody is happy about taking any action which inconveniences patients, but the nature of a doctor's job means it's almost impossible to find anything that won't do that. So that's why we emphasise public safety. I really hope that we can find a resolution to this. Nobody is happy about this. No doctor wants to do this." The Department of Health's figures should be "treated with extreme caution", the union says. While the DoH claimed that 9% of normal daily non-urgent elective operations had to be rescheduled, the BMA says the true figure was more like 25%.
On ITV's Daybreak, Meldrum responded to Andrew Lansley's claim that the strike would be "pointless". Similarly, it also disputes the DoH's claim that three-quarters of GPs' surgeries in England offered the full range of normal services. One third joined the action, it insists.
I hope [the action] is not pointless and futile because we are very anxious to seek a resolution to this dispute and if this helps to highlight the problem and to get to that resolution then I hope it will have some point to it … Here's the statement the BMA has just released:
We doctors have enjoyed a good relationship, high trust, with their patients and we don't want to do anything to get rid of that, but what we feel we've had is lack of trust from the government. "Because doctors have been in their places of work as usual, it was always going to be difficult to put a figure on the number taking part - the government's figures need to be treated with extreme caution. Our feedback from the doctors co-ordinating the action on the ground indicates that in England up to a quarter of non-urgent cases have been postponed, and around a third of GP practices have been taking some form of action. Our intention has not been to maximise the impact on patients, but to communicate the scale of doctors' anger and to encourage the government back to the table. Doctors have sent a strong message that a fairer approach must be found."
We negotiated a deal on pensions four years ago that meant that doctors would work longer, they would pay more and that they would take the risk of any future increase or impact of people living longer on the pension scheme and the government has walked away from that deal. I hope that after today we can sit down and we can talk. 5.59pm: Yesterday doctor and journalist Kate Adams spoke to a consultant who mentioned that the management team at Newcastle Hospitals has a reputation for being aggressive towards staff during times of industrial action. She has just heard from one their junior doctors:
On the same programme, Lansley urged doctors not to participate: Lots of frustration from juniors in Newcastle Hospitals who wanted to take action but were prevented by trust policy which states that all ward-based in-patient activity must continue. Very disappointing. A robust challenge to the Trust's obstructive management style would be needed in advance of any further days of industrial action here.
I know doctors don't want to go on strike. I hope they don't. I think if they have an argument and they're angry, they're angry with the government and that's our job to represent the taxpayer and the public interest, and maybe we will have that argument. But I can't see why anybody thinks there is any benefit in penalising patients. It won't serve any purpose whatsoever. Dr Tim Walls, Newcastle's medical director, responded:
The last time doctors took action was in 1975, when consultants suspended goodwill activities and worked to contract over a contractual dispute, and junior doctors worked to a 40-hour week because of dissatisfaction with the progress of contract negotiations. The trust recognises in principle the right of an employee to take lawful industrial action in response to a national dispute and there has been very good cooperation from the BMA in enabling the trust to deliver emergency and urgent care. We simply don't recognise the behaviour alleged by a junior doctor.
9.00am: Hello, and welcome to today's live coverage of the first doctors' strike in almost 40 years. Hospitals elsewhere seem to have been more reasonable. One of the consultants in Sheffield told me that the hospital had been very reasonable wanting to work with the union and recognising that this is a national not a local disagreement.
The effect of the industrial action – over changes to doctors' pensions that they regard as unfair and unnecessary – is difficult to predict. 6.06pm: In Northern Ireland, a total of 897 patients were affected by either cancelled appointments or cancelled operations today, according to the NHS.
Not all doctors are taking part. About a third do not belong to the British Medical Association, which has called the action, and when the BMA balloted its members last month 21% of GPs and 15.7% of hospital consultants said they would not participate, on turnouts of 53.1% and 56% respectively. The BMA said that more than half of GPs' practices participated.
Nevertheless, services in hospitals and GPs' surgeries in many areas will be affected. But unlike in most industrial disputes, doctors will still attend their workplaces as usual, continuing to deal with urgent and emergency cases, and only refusing to attend to routine and non-urgent appointments and consultations. So it should be business as usual in A&E departments, maternity units, for renal and cancer patients, and anyone needing an urgent diagnostic test or end-of-life care, while 80% of UK hospitals, according to the BMA, have cancelled some planned operations and some outpatient appointments. We have had no NHS figures for Wales yet, but the BMA claims that at least 50% of routine GP appointments and a range of surgical concerns have been cancelled. "Almost every hospital site in Wales has participated," said a BMA spokeswoman. "Of these sites well over 50% and up to 75% staff participation."
Andrew Lansley, the health secretary, has claimed that 30,000 operations will be cancelled, 1.25m GP appointments delayed, 58,000 diagnostic tests postponed, and 200,000 outpatient appointments rescheduled. But there is no way of verifying these figures because the Department of Health has asked NHS trusts not to release such details to the media. The DoH may release a summary of the impact later on today. 6.06pm: Here is a summary of today's key events so far.
We will be reporting on the impact of the doctors' day of action live here throughout the day. • A large minority of GPs' surgeries have been affected in some way by today's industrial action by doctors, the first such action in almost 40 years. According to the Department of Health, a quarter of surgeries have been affected, while the British Medical Association says the figure is a third. Doctors are protesting against changes to their pensions that they say are unfair and unnecessary.
• Unlike in most industrial disputes, however, those who are taking part are still turning up to work and dealing with urgent and emergency cases; only routine and non-urgent appointments have been postponed. About one in 10 patients who were due to receive routine or planned non-urgent NHS care today have had it postponed, according to the DoH. The BMA says that figure is more like 25%.
• Andrew Lansley, the health secretary, said he was pleased that "the majority of doctors" had maintained services for patients, but added: "Thousands of patients who expected to have an operation or an appointment today have been inconvenienced or distressed by delay to their care" (see 2.33pm). The BMA's Hamish Meldrum said: "Our intention was not to maximise impact on patients, but to communicate the scale of doctors' angers and to encourage the government back to the table" (see 2.44pm). Later Lansley was more emollient, saying: "When you look at the number of doctors who've taken part in strike action, is not that they don't necessarily have a grievance about their pension arrangements, but that they don't think it's right to prejudice patients, they don't think it's right for patients to suffer or to be distressed as a consequence of that, and they put patients first. The BMA should ... join the other trade unions ... who are discussing with us the implementation of the agreement we collectively arrived at. "
• The BMA accused the government of making "misleading" comments about doctors' pension reforms and of presenting "partial representations of the facts" (see 12.42pm).