Doctors in Cheshire and Merseyside believe targets imposed on trusts to save money are putting patients at risk and destabilising services.
Doctors say that NHS England have imposed financial restrictions on Integrated Care Boards (ICB) – the NHS organisations which plan and manage healthcare services in a region – and NHS trusts that are damaging patient care and resulting in unreasonable consequences for staff. As a result of these funding restrictions, the ICB in Cheshire and Mersey have introduced recruitment freezes, plan to reduce staffing levels despite significant workload demands, limits/bans on agency workers, and imposed a unilateral reduction of overtime rates.
In a BMA survey in the region, 88% of respondents said they believe that funding cuts are seriously harming the delivery of safe patient services. 92% of respondents to the survey support formally entering a trade dispute should the matter not be resolved, and 80% of respondents support industrial action should it be deemed necessary.
Doctors are saying they are “overwhelmed” and that morale amongst staff is at an all-time low, with many left to cover unmanageable patient numbers with staffing cover that does not meet required safe levels.
A doctor working in the Cheshire and Merseyside region who qualified two years ago, said:
“Currently staffing levels feel really unsafe. As a second year doctor I have had shifts where I have been responsible for 30 very poorly patients on my own, all while being pulled in every direction to different departments. It takes so long to get through them all that it’s leaving patients with potentially life-threatening conditions waiting to be seen for up to 8 hours. It’s such an overwhelming situation to be in and you know that you aren’t giving patients the best care, but it’s out of your hands. What we need is more doctors on shift, but these cuts to pay mean these shifts just aren’t being filled.”
Cuts to payments for routine and essential extra work undertaken by resident doctors and Specialty, Associate Specialist and Specialist (SAS) doctors, imposed by the ICB, have seen as much as a 27% reduction in pay. This has inevitably caused a lower uptake of those extra shifts and unsafe staffing levels, putting patient safety at risk.
Due to low staffing levels, consultants are warning that they are being stretched to cover the shifts of more junior doctors. This is causing routine surgery and treatment to be cancelled to enable consultants to rest.
Of the resident and SAS doctors who responded to the survey, 84% said their health, wellbeing and working conditions had worsened because of the ICB and NHS England’s approach.
A specialty registrar working in the Cheshire and Merseyside region said:
“Morale is at an all-time low. By the end of my shifts, I am so exhausted that I am struggling to make the life-or-death decisions expected of me, but when I get home, I can’t sleep because I am so worried about it all playing out again on my next shift. I have had several shifts when I was the only registrar, when we are meant to have at least two to meet safe staffing standards. The pressures and responsibilities that fall on my shoulders are simply too demanding to cope with without support. The problem won’t be solved when doctors are expected to take a pay cut to deal with these demands.”
Warning about impact on consultants and the destabilisation of patient care, Dr Den Langhor, BMA Mersey regional consultants committee chair and a consultant working in Mersey, said:
“We have taken this stand to protect not only staff across Cheshire and Merseyside, but to keep patients safe, so they can get the quality of care they deserve. Make no mistake that the ICB’s drive to save money comes with the very real cost of patient safety.
“Consultants in the Cheshire and Mersey region are being forced to plug rota gaps, overseeing busy wards with not enough staff. This is having a catastrophic impact on hospital capacity, destabilising services and seriously compromising patient care. The ICB must reverse these hugely damaging funding cuts that hit staff and patients’ staff most of all.”
Calling on the ICB to reserve cuts to pay and ensure safe staffing levels for doctors, Dr Kartik Goyal, co-chair of the BMA’s Mersey regional resident doctors committee, said:
“Resident doctors are working themselves to the bone, going above and beyond their normal hours in impossible circumstances trying to keep patients safe. The demands are putting them at risk of burnout, but their hard work and dedication have been rewarded with lots of trusts cutting overtime rates. Inevitably, this means a significantly lower uptake in extra shifts and leaving unsafe rota gaps. These cuts must be reversed so we can have safe staffing levels and doctors can provide the quality of care that patients in Cheshire and Mersey rightly expect.”
Notes to editors
Doctors' demands are as follows:
Immediately reinstate deficit support funding for Cheshire and Merseyside and ensure that trusts and other providers have the required level of funding to provide safe and effective patient care. To do this;
- Give local leaders who know the local system best back control to make the decisions required to deliver system improvements.
- Abolish the blanket cost reduction policies that have been implemented and instead allow decisions to be taken on clinical rather than financial grounds. This would include a removal of recruitment freezes, enforced targets for reductions in staff headcount, and removal of caps on overtime payments;
- Support changes to the way services are organised and delivered, including investment in buildings and equipment, so that they can work more efficiently, avoid duplication of work, and work more closely and effectively across different specialities.
- Ensure that in future the ICB and NHS England work with staff to deliver service improvements.
The survey was carried out between October and December 2025. Each question had 970 responses.
Questions
What impact do you think the ICB funding restrictions is having on patient safety?
The ICB is seriously harming the delivery of safe patient services
87.9% 853 responses
The ICB is slightly harming the delivery of safe patient services
10.2% 99 responses
The ICB is not having an impact on patient safety
1.4% 14 responses
The ICB is slightly improving the delivery of safe patient services
0.3% 3 responses
The ICB is greatly improving the delivery of safe patient services
0.1% 1 response
If the BMA balloted members across the region for local or regional industrial action (including both actions short of a strike and strike action), how would you vote?
Yes – I would support industrial action
79.6% 773 responses
No – I would not support industrial action
6.7% 65 responses
Don’t know/ undecided
13.6% 132 responses
Do you support the BMA decision to enter a formal trade dispute over the imposed funding restrictions in Cheshire and Mersey?
Yes
91.5% 889 responses
No
2.7% 27 responses
Don’t know/undecided
5.5% 54 responses
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