Junior doctors’ strike day two: A&Es could shut or only treat ambulance patients

Emergency departments across England may be forced to shut later this week amid the junior doctors’ strike, health chiefs fear.

A&E units could close parts of their services, such as minor injury units, or only treat patients who arrive by ambulance, according to the country’s top emergency medic.

The move would be a result of hospital ‘not coping’ during the junior doctors’ strike, which has seen 47,000 medics walk out from Tuesday to Saturday morning.

The British Medical Association (BMA), which is orchestrating the action in a bid for a 35 per cent pay rise for the workforce, would have to halve its demand to get ministers around the table, officials have suggested.

However, the union, whose co-chair is on holiday this week, has said its figure is not a ‘tall ask’ and will only call off industrial action if Health Secretary Steve Barclay makes a ‘credible offer’.

Up to 350,000 appointments will be cancelled this week due to the walkout, with Brits telling of their children’s cancer surgery being postponed.

Junior doctors on the picket line outside The Royal Berkshire Hospital in Reading on April 12 

Dr Adrian Boyle, president of the Royal College of Emergency Medicine, told The Times that the majority of A&E units will cope during the 96-hour walkout but ‘it will be very tight’.

This is because emergency care is operating with just 40 to 60 per cent of its usual workforce, as it has been more difficult to get senior medics to fill in for striking junior doctors this time round.

The walkut immediately follows the four-day bank holiday weekend, when many senior medics are on annual leave or have childcare commitments.

Dr Boyle said: ‘If A&E departments are not coping they will end up closing parts of the services.’

This could include hospitals closing minor injuries units, which would see patients with non life-threatening injuries turned away and told to see their GP instead, he said. Or hospitals may decide to only treat patients arriving by ambulnace. 

Dr Boyle added: ‘They will try and stay open but provide reduced cover. We are more likely to see that this time round [than in previous strikes]. 

‘The level of disruption is greater and the strikes are longer.’

Up to half of doctors in England took to picket lines from 7am this morning, in action that will run until 7am on Saturday, marking the ‘longest period of industrial action’ that the NHS has ever seen.

The BMA is seeking a 35 per cent pay rise to address the 26 per cent real terms pay cut junior doctors have faced over the last 15 years. 

Starting salaries for junior doctors are £29,384 for the first year. This rises to £58,398 by the end of their training and within six years of graduating from university, they can earn £120,000 as a consultant.

The BMA has said it is ‘willing to negotiate on how to achieve pay restoration’. 

Mr Barclay has insisted that this demand is unaffordable, saying it would cost £2billion and give some medics a £20,000 pay rise.

But the BMA compared the amount to a quarter of the cost of unusable PPE bought by the Government, ‘137th of the money that was wasted on a test and trace system’ and the amount given to rail companies to ‘not settle the rail dispute’. 

The Government has said it will negotiate with the BMA if it removes its 35 per cent ‘starting point’ and calls of its strike.

Ministers have not publicly set an acceptable pay increase but the i reported that 17 to 19 per cent would be ‘seen as a basis for meaningful talks’.

Professor Philip Banfield, chair of council at the BMA, admitted this morning that ‘we do need someone to start brokering realistic talks’, revealing that he is in discussion with dispute resolution service Acas.

He told Times Radio: ‘I have been talking to Acas about the possibility of breaking down some of the preconditions that have been put on the juniors by this Government to try and get this dispute resolved as quickly as possible.’ 

Professor Banfield said the union has ‘come up with lots of suggestions’ on how to get into talks and will continue to apply ‘every effort’ during and after the strike.

‘We are very keen to get this resolved as quickly as possible,’ he added. 

Oscar was diagnosed with rhabdomyosarcoma — a cancer affecting soft tissue around the body — in November 2021. He was scheduled to have exploratory surgery at Great Ormond Street Hospital on April 11 to check if it had returned but it has been postponed by more than two weeks to April 27

Rebecca Lawson’s operation to find the cause of chronic stomach pain has been cancelled three times because of different NHS strikes – despite her paying to have it done privately

The NHS said it will continue to prioritise emergency, critical, neonatal, maternity and trauma care during the action.

But it has warned that ‘hundreds of thousands’ of appointments, including cancer care, will be postponed and there will be ‘significant impact’ on local services. 

Mr Barclay accused the BMA of putting patients at ‘greater risk’ after not agreeing any national exemptions for some services, which other striking unions did.

Brits have told of their children’s cancer operations being postponed, while other patients have spoken of ‘mess’ of having their appointment repeatedly postponed.

Shelley Warrent, 28, revealed her three-year-old son’s exploratory surgery to check for the possible recurrence of cancer, was postponed due to the action.

Oscar was diagnosed with rhabdomyosarcoma — a cancer affecting soft tissue around the body — in November 2021.

While he was later declared cancer-free, a three-month check-up in March raised concerns that his cancer may have returned.

He was scheduled to have exploratory surgery at Great Ormond Street Hospital yesterday but it has been postponed by more than two weeks to April 27.

Mrs Warrent, from Norwich, said the care her three-year-old son has received is ‘amazing’ but added: ‘I’ve expressed my concern at postponing the surgery as, if it is cancer, it will give it more time to get worse.’

Meanwhile, Rebecca Lawson’s operation to find the cause of chronic stomach pain has been cancelled three times because of different NHS strikes – despite her paying to have it done privately.

Mrs Lawson, 43, from West Sussex, said she was ‘constantly being told’ the doctors were unavailable to carry out private work because they were covering for strikes. ‘It’s just a mess,’ she added.

And a girl of ten had an appointment for an procedure on a serious leg injury cancelled at Birmingham Children’s Hospital. Her mother, who asked not to be named, said: ‘My child is suffering.’

One breast cancer survivor, Jackie Pugh from Shropshire, revealed she has been waiting nearly three and a half years for breast reconstruction surgery after having treatment.

Her operation was set to take place on Friday but was cancelled because of the junior doctors’ strike.

‘I’m just really, really upset that it is off. I don’t know when it is going to be rescheduled,’ she told the BBC.

Ms Pugh said she was getting herself ready for the surgery, but the four-day action means she has to rethink things. 

Her husband was also recently diagnosed with cancer, and Ms Pugh had planned to take care of him after his chemotherapy.

‘I needed my operation to go ahead so that I could look after him when he is recovering, because chemotherapy is not the nicest of treatments,’ she said.

While patients face ‘the most disruptive period of action in NHS history’, Dr Robert Laurenson (pictured), co-chair of the BMA’s junior doctors committee, is absent from picket lines as he is on holiday

The BMA has highlighted the low pay as part of a new advertising campaign in support of the pay dispute by junior doctors in England

Junior doctors stand on a picket line outside University College Hospital in central London on April 12

Junior doctors stand on a picket line outside University College Hospital in central London on April 12

Junior doctors stand on a picket line outside University College Hospital in central London on April 12

NHS Providers warned that the 96-hour walkout will cause a ‘very long, difficult week’ for the health service

While patients face ‘the most disruptive period of action in NHS history’, Dr Robert Laurenson, co-chair of the BMA’s junior doctors committee, is absent from picket lines as he is on holiday.

The union confirmed the 28-year-old is off all week to attend a friend’s wedding. 

It means the trainee GP in Kent will likely be paid during this round of strike action, if he took annual leave, while striking doctors do not receive their salary.

On picket lines yesterday, Hamish Bain, 29, a neurology trainee at University College Hospital, London led striking doctors in singing about Mr Barclay to the tune of I Want It That Way by the Backstreet Boys.

They sang: ‘We are on fire, burnt out and tired. Hear us when we say, we just want fair pay.

‘Steve, we’re too far apart, don’t you have a heart, when you say, we won’t adjust your pay?

‘Tell me why, there’s money for track and trace. Tell me why, and masks that cover up our face. Tell me why, I really really want to stay, just give us fair pay.’

It comes after hospital bosses yesterday expressed concern about keeping patients safe as they struggle to secure cover for overnight junior doctor shifts during strikes.

Miriam Deakin, director of policy and strategy at NHS Providers, said: ‘Getting through today is just the start. 

‘Trust leaders are worried about securing adequate cover for the night shifts ahead. This is going to be a very long, difficult week for the NHS.’

Professor Sir Stephen Powis, NHS England’s national medical director, said: ‘Staff are working incredibly hard during this unprecedented period of industrial action, and we expect the situation to become more challenging each day this strike progresses.

‘As the week goes on, we expect to see staff cover stretched as those who worked tirelessly over the Easter holiday take leave, which will pose a huge challenge to an already depleted workforce.’

But the BMA said it has already stepped in when needed, asking seven junior doctors to return to work at Weston General Hospital in Weston-Super-Mare after it was left with no doctors in its emergency department. 

Under NHS contingency plans, hospital leaders can request for doctors to return to work for a limited time in certain circumstances ‘to maintain safe patient care’.

The BMA said today: ‘Protecting patient safety during strikes has always been a priority to the BMA. 

‘However, poor planning by local management has left the Emergency Department and acute medicine at Weston General Hospital exposed.

‘As a result, the BMA has agreed that a total of seven junior doctors can be asked to volunteer to return to work today and tomorrow.’