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Hospital leaders warned that failure to recall striking doctors risked patient safety in some trusts, documents show

BMJ 2024; 384 doi: (Published 28 March 2024) Cite this as: BMJ 2024;384:q740
  1. Gareth Iacobucci
  1. The BMJ

Documents obtained by The BMJ have shed new light on the process of derogation, which is designed to protect patients during industrial action by health workers. Gareth Iacobucci reports

An investigation by The BMJ has revealed new details of requests to recall striking junior doctors from picket lines for patient safety reasons. While most trusts in England did not make such requests, those that did were rejected by the BMA in most cases. Some of these trusts warned of potential harm to patients from cancelling operations at the last minute and short staffing.

The BMA said that it took concerns around patient safety “incredibly seriously” and that poor planning by some trusts had led to some routine care being inappropriately booked in on strike days. In other instances, said the BMA, trusts had failed to make sufficient effort to draft in the necessary cover for strike days.

Documents disclosed to The BMJ show that over 90% of NHS trusts (83 of 90 respondents) that responded to a freedom of information (FOI) request did not make any derogation requests during the first nine strikes by junior doctors from March 2023 to January 2024. The remaining seven trusts made 27 derogation requests between them, of which 24 (89%) were rejected by the BMA, one (4%) was approved, and two (7%) were withdrawn by the trust.

The BMJ sent FOI requests to 135 NHS trusts in England and received 90 responses (a 67% response rate) to better understand the performance of derogation—the process designed to keep patients safe during times of industrial action. Derogation allows trusts to ask for staff to be exempt from strikes if they believe that patient safety is at risk.

The documents show that in some cases trusts that submitted derogation requests were able to find last minute cover …

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