BMA and Royal College of Nursing raise concerns about NHS staff still being made to work overtime often unpaid

by BMA media office

BMA press release

Location: England
Published: Saturday 8 May 2021
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Thousands of doctors and nursing staff say they feel under pressure from employers to work extra shifts, often unpaid.

Some doctors say they are already exhausted and fear that they will be pressured to do extra shifts without adequate rest to help reduce the huge backlog of patients needing treatment in NHS hospitals.

More than five and a half thousand doctors responded to the latest BMA ‘tracker’ survey1; and the findings revealed that over half of the doctors surveyed in the UK had worked extra hours (58.1%), with around a third of them (28.5%) reporting that these hours were unpaid. Nearly half (44.2%) of the doctors who responded felt pressured by their employer to do extra hours, while over a third (36%) had either skipped taking full breaks altogether or taken them on rare occasions. This has left staff exhausted with nearly 60% of doctors reporting a higher than normal level of fatigue or exhaustion.

These experiences are also echoed among registered nurses (RNs) and nursing support workers as figures from the Royal College of Nursing’s survey of members’ experience of the pandemic2. In July 2020, one third of nursing staff in all sectors reported they are working longer hours. Of these, 40% of respondents are not being paid for the additional hours, with a further 18% only sometimes being paid.

Meanwhile, the latest NHS England staff survey3 found that over 65% of RNs and a third (30.4%) of nursing support workers worked extra hours that were unpaid. These figures also showed that around half of all nursing staff worked in the previous three months despite not feeling well enough to do so and that a quarter felt under pressure from their manager to work when unwell.  

Dr Chaand Nagpaul, BMA council chair, said: “To learn that an already depleted and now exhausted workforce feels forced into doing more and more hours, with many reporting higher levels of fatigue than ever, is extremely worrying. It is putting them at risk and their patients. Working ‘flat out’ without a change to rest and recuperate is simply unsustainable and unsafe.

“The results from the latest BMA’s COVID-19 tracker survey show that far too many colleagues across the NHS are experiencing unacceptable levels of exhaustion while being pressured to work extra shifts, and this needs to be addressed as a matter of urgency. Governments should be doing all they can to ensure staff have an opportunity to rest and reset – no one should feel pressured to take the NHS backlogs on a goodwill basis.”

Royal College of Nursing Acting Chief Executive and General Secretary, Pat Cullen, said: “Exhausted health and care staff, without whom we would not have turned the tide of the pandemic, must be supported to recover.

“We cannot return to the understaffed wards, care homes and clinics from before the pandemic. Investment in staffing and pay is about both patient safety and the health of our workers.

“After this experience, nursing staff expect decisive action and investment to guarantee there are enough highly-skilled health care workers to meet our country’s needs now and in the future.

“That means leaders must take steps to retain the nursing staff we have, as well as to increase entry into the profession.”

A surgeon from Berkshire, said: “Given just how severe the impact of COVID has been on the healthcare system it’s no surprise that staff are simply dog tired, and we were still having to work very differently putting in an ever-rising number of hours in order to deal with backlogs that have developed over the last year.

“We haven’t had a break since the first wave, we're being asked to do a lot of additional work to catch-up and I honestly don’t know how long the workforce can continue working beyond maximum effort. The fact is, it’s going to take a lot more than shattered doctor’s goodwill for the health service to get through these backlogs.”

A doctor from the South West of England, said: “I know from colleagues that some staff still haven’t been able to take annual leave, so frankly it’s not surprising to learn that so many doctors are worn out. It’s high time the Government start listening to our concerns - NHS staff need practical support and the opportunity to recover and really come to terms with the viciousness of this pandemic.

“To restore the NHS, those working within it must be able to access to independent occupational health services that are competent enough to assess and diagnose the cause of stresses and advise on supportive interventions – give staff a chance to recover and rest and we’ll be in a better position to work together to restore our beloved NHS.”

A Critical care sister nurse from Hampshire, said: “Vast numbers of nurses are burnt out, experiencing severe anxiety, depression, and PTSD - speaking from experience myself, the struggle is very real. We now have the huge task of ‘catching up’ with cases that were put on hold during the pandemic, so for us the work is not over.

“I worry for the safety of patients, as well as staff, as we start to tackle this mountain. Unsafe staffing levels compromise the care and safety of our patients. We need to be attracting staff into the profession and a meaningful pay uplift such as what the RCN is demanding, will hopefully go some way to rectify the problem.

“We simply cannot continue in this way, and until this Government acts on our concerns I remain gravely concerned for the future of the NHS workforce.” 

As lockdown restrictions begin to ease across the UK, the BMA and RCN want to ensure that Governments do not rely on the goodwill of NHS staff to deal with current backlogs. Instead UK Governments should look to ensure that services resume in a way that is safe for both patients and those providing care. To do so, all Governments and system leaders across the UK must start having honest and open conversations with the public about what the NHS can realistically deliver so that an accurate expectation is set. Governments must also commit to developing a robust plan, which addresses actions outlined in the BMA’s Rest, recover, restore report4 and the RCN’s Principles for return to service – staff recovery and patient safety5, including:

  • Prioritising protecting the health, safety, and mental wellbeing of the workforce;
  • Providing the service with additional resourcing dedicated to helping to tackle NHS backlogs;
  • Ensuring that staff with signs of stress have access to a rapid referral, including self-referral, independent specialist occupational physician-led service;
  • Expanding the healthcare system’s capacity;
  • Putting measures in place expand the medical workforce.


Notes to editors

The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

  1. BMA COVID-19 survey April 2021

57.11% described higher than normal levels of fatigue or exhaustion from working or studying during this pandemic

58.13% said they undertook additional hours' work over and above their contractual requirement as part of the response to Covid

28.45% said these additional hours were unpaid

44.2% said they felt pressured by their employer to work additional hours

36.02% said that they took breaks in full either never (14.72%) or rarely (21.30%)

2. Royal College of Nursing’s survey of members’ experience of the pandemic

3. Latest NHS England staff survey

4. BMA Rest, recover, restore: Getting UK health services back on track

5. Royal College of Nursing Principles for return to service – staff recovery and patient safety