What to do on the day

Advance planning

Employers are given advance notice of the dates of industrial action. This means there is time for all planned activity to be cancelled in advance and to minimise disruption to patients. It also provides employers the notice required to make appropriate arrangements around activity in the days leading up to the days of strike. In most cases, no clinical activity can go ahead in the hospital without the presence or supervision of a consultant, even if that supervision is remote.

Defining ‘emergency care only’

You will only be expected to provide the same level of service that you would on Christmas Day. Care being delivered by resident doctors, specialty doctors and allied health professionals that would usually happen with your remote supervision will also need to be cancelled.

On-call responsibilities

In a department where all consultants are striking, we suggest that the consultant who is scheduled to be on-call out of hours on a day of action would typically be the one providing the emergency cover.

Emergency cover

If there are consultants in a department who are not striking, and the person who is nominally on-call wishes to strike, they have a legal right to do so. In this circumstance, it is down to the employer to arrange how the emergency cover will be provided and if this is agreed to be undertaken by a consultant who would not normally be providing this cover, this work is extra contractual and BMA rates ought to be paid.

Deferring work

As a consequence of industrial action, some work will not be done, and some will be deferred. This might include clinical or administrative work, and is due to the loss of NHS capacity during industrial action. While the NHS will need to consider how to catch up with lost capacity, your employer cannot require you to undertake extra work in your own time to catch up. You are under no obligation to undertake this work on top of your usual activity, and where you do so, you should only agree to deliver it in line with the BMA rate card. The BMA will support doctors who are asked to make up time lost to industrial action.

Emergency attendance

Most consultants will be providing an on-call only service, in the same way as they would on Christmas Day. You should remain contactable in case of emergency during the on-call period.

Non-clinical activities

These do not constitute emergency care and so, if you are taking part in industrial action, you should not undertake them. Examples would be teaching students, training courses, clinical audit and governance, appraisal or educational supervisor meetings, research, management and administration.

Additional NHS responsibilities and external duties

These do not constitute emergency care and so if you are taking part in industrial action you should not undertake them, unless they are being delivered on behalf of another non-NHS employer (e.g. a university employer). Examples include conducting interviews for specialty training recruitment, and so on.

Facilitating medical school exams

We are mindful that the progression of medical students is critical to the health system. To minimise disruption to medical school exams, consultants can still take part in administering these exams. However, to avoid distorting strike participation rates, we would urge you to apply in advance for professional leave on days of action in order to take part in administering these exams. Such activity should, in any case, be undertaken during professional leave.

If you're not scheduled to work

If you are not scheduled to work on a particular day of action, you personally would not need to take industrial action. You cannot have your wages deducted on this day either.

You are fully entitled to join in organised activities on the day, such as picketing, and we would encourage you to do so.

Working for a non-NHS employer

If you are scheduled to deliver work for a non-NHS employer on a day of action, including pre-existing private practice commitments, you will still need to attend and deliver that work as normal. Non-NHS employers are not covered by this industrial action.

If you were scheduled to be working for the NHS on a day of action, you may take industrial action but you should not make new arrangements to perform any Private Practice activity instead of your usual NHS work.

Consultant clinical academics cannot take part in this industrial action because they are employed by university/HEI employers with which the BMA is not in dispute (while generally also holding honorary contracts with NHS employers).

If you’re not taking industrial action

The BMA wholly respects an individual's right not to participate in industrial action, but recognises that differences in opinion on this subject can be quite marked. Both doctors who are participating and those who are not should respect each other’s right to do so. There should be no coercion of colleagues, to either take part or not.

However, even if you are not taking part in industrial action yourself, other colleagues will be and as such your service may not be able to function as normal. You must be aware that you might be putting patient safety at risk if you proceed with non-emergency and elective work.

If you attend work and do not participate in strike action your employer can ask you to undertake alternative duties which are reasonably incidental to your job plan. This may include, for example, exchanging SPA work for clinical activity, or undertaking a different type of clinical work. All requests for amended duties must be reasonable, fall within your skillset and existing hours of work. Any requests which are not in line with these requirements are extra-contractual and should be compensated as such.

Patient care

We know that, as service leaders, consultants may have concerns about patients in their particular specialty (e.g., oncology, paediatrics, etc.) and the impact that industrial action would have on them. That is why we have specifically provided employers with sufficient informal notice about the dates we intended to take industrial action, and more than twice the legally required notice period. We wanted to give hospital Trusts and colleagues enough time to prioritise and reschedule the most urgent cases and minimise the impact on those patients.

Dealing with pressure to return to work

Contact us if you are under pressure to return

If you feel you are coming under pressure from anyone to participate in delivering care that is clearly not emergency care, you should contact your designated local representative, who will be clearly identified on the day.  We will support any consultant BMA member who is pressured to return to work. If you believe you are being pressured to go back to work, you should contact us as soon as possible. However, your local representative is better placed to intervene on the day. It is important that you keep a note of what happened, including retaining emails.

Wherever possible, action is best taken collectively, so make sure you know which other doctors in your department are participating and group together on the day for mutual support. A number of Trust all-consultant WhatsApp groups have been set up to allow consultants to communicate and coordinate. You can also contact members of your Local Negotiating Committee (LNC) for advice and support.

There are formal derogations processes agreed between the BMA and the NHS (see below). Employers therefore have their own routes for escalation that should be used, rather than pressurising individuals.

Under which circumstances can I be called in?

A major incident could take a number of forms. For example, a major accident or security incident.

The pressure which hospitals find themselves under on a regular, sometimes daily basis does not constitute such an event. Your Trust calling a critical incident will not in itself meet our criteria. In the event of a “major incident” the Trust should urgently contact NHS England through the appropriate derogation process. If NHS England agree that the situation may justify asking additional consultants who would otherwise be delivering non-emergency work to return to work, such request will be submitted to the BMA at a national level for urgent consideration.

However, given that consultant action will not affect emergency service provision, we do not anticipate that this will be necessary.

In the event of an externally declared major or mass casualty incident that affects the normal resources of the emergency and healthcare services’ ability to manage, we have a clear process agreed with NHS England set out. Derogations (exemptions from industrial action) will first need to be agreed by the BMA at a national level. If there is a derogation at your department or Trust, you will be asked to return to work by your Trust and we will confirm this on our X account and strike action toolkit as soon as possible. Please always check for a verification from the BMA.

If your employer takes action against you

In cases where an employer takes action against a BMA member as a result of their involvement in industrial action, the BMA would provide support under the terms of the My BMA contract of membership. Please refer to this for more details.

Other considerations