Hospitals can ask striking doctors to return to work - but under what circumstances?

Medical staff could be called back to work even if they are participating in the NHS strikes

By ITV News Producer Hannah Ward-Glenton

The largest junior doctors' strike in history is currently underway in England, with six days of walkouts planned from 7am on January 3 to 7am on January 9.

But there are circumstances under which medical staff can be called back to work even if they are participating in the strikes.

A number of hospitals have put in formal requests to the union, the British Medical Association (BMA), urging for their junior doctors to be exempt from the strike amid severe pressure on services with some declaring critical incidents.

Under what circumstances can junior doctors be recalled to work?

NHS England and the BMA have agreed patient safety should be a priority while strikes are happening, and while there are contingency plans in place, such as bringing in additional consultants to cover those shifts, junior doctors may be requested to return to work.

They may be recalled due to "unpredictable events, major incidents, and unexpected and extreme circumstances".

Asking for junior doctors to be made exempt from the strikes is known as a derogation request.

The BMA and NHS England outlined the situations in which junior doctors may be recalled to work in a joint letter in April.

"It may be necessary, as an exception, for a trust to contact junior doctors in the event of a mass casualty event, explaining the situation and seeking their return to work," the letter states.

If an NHS trust decides what it is experiencing is a critical incident, it contacts NHS England, who will then decide whether or not the situation justifies asking junior doctors to return to work. If NHS England agrees that it is justified, the request is then submitted to the BMA for final approval.

NHS trusts are expected to be able to show they have exhausted all other staffing options before asking junior doctors to return to work, and the BMA specifies that "the pressure which hospitals find themselves under on a regular, sometimes daily basis does not constitute [a critical incident]".

If a derogation request is approved, junior doctors will be asked to return to work by their local trust or department, and the information will be verified by the BMA online.

A system on the verge of collapse?

The BMA said on Thursday the derogation system itself is now at risk of collapse because NHS bosses are not providing the evidence to show they have tried all possible alternatives for staffing.

BMA chairman Professor Philip Banfield said it "is fundamentally undermining the derogation process" and that NHS England "is willfully placing the BMA in an impossible situation."

Mr Banfield also said the BMA had received derogation requests on December 29, which he said should that "little to no effort has gone into seeking an alternative solution" to staff shortages as a result of the strikes.

The letter from the British Medical Association was posted on X, formerly known as Twitter.

NHS Confederation Chief Executive Matthew Taylor responded to the letter by saying NHS trusts had been working "at pace" to prepare for the strikes and that rather than refusing to provide required information, staff were trying to limit the time spent "filling in forms when patient safety could be at risk."

"Not all NHS organisations have a wide range of alternative staffing arrangements at their fingertips – especially so soon after Christmas when many schools are still closed," he added.

So will junior doctors be called back to work?

More than 20 requests have already been made by hospitals for junior doctors to return to work due to patient safety concerns.

Several NHS trusts have already declared critical incidents, with emergency services feeling the pressure at one of the busiest times of the year.

Queen Alexandra Hospital in Portsmouth said its A&E department was “full” as it declared a critical incident, while NHS Nottingham and Nottinghamshire Integrated Care Board said it was experiencing “significant pressures on services”.

Other hospitals reported “extreme heightened pressure” and being “exceptionally busy”, with one citing A&E waits of “up to 11 hours”.

Senior NHS leaders said that longer wait times would be difficult to avoid as a result of the strikes.

“Because of the considerable impact these strikes will have, services are likely to feel different for patients, and longer waits are almost inevitable," said Dr David Levy, the medical director at NHS Lancashire and South Cumbria Integrated Care Board.

At the time of writing all but one of the requests have been rejected, and the final one is being considered by the union.

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