Doctors’ strikes can have surprising benefits – but are they sustainable?
Doctors’ strikes can have surprising benefits – but are they sustainable?
When the latest doctors’ strike in England concluded, NHS trust leaders shared observations that the system had operated with unexpected efficiency. Some noted that the process had been smoother than usual, even as they acknowledged the temporary nature of such solutions. The December walkout, involving around 25,000 doctors, was initially criticized by ministers as “irresponsible and dangerous,” yet within certain hospitals, the outcomes were markedly different.
“We sighed with relief — strikes act like a firebreak,”
recalled a hospital manager reflecting on the December 2023 walkout by British Medical Association (BMA) members. The timing of the strike, aligned with the Christmas season, coincided with a period when hospitals typically experience a slowdown. The trust chief executive noted that the absence of resident doctors created an environment where consultants could take charge, leading to quicker decisions and reduced bed occupancy. This, they said, was a “gift” for the NHS.
At King’s College Hospital, a study found that patient care during the first junior doctor strikes in 2023 was expedited, with faster treatment and discharge times despite fewer staff. Researchers reported no increase in mortality or readmissions, suggesting that the strikes had a positive impact on emergency department performance. Similar trends were observed at the Royal Berkshire Hospital, where the four-hour A&E target was met in 82% of cases during the December walkout, compared to 73% the prior week.
Shorter waits, calmer corridors
Trust leaders highlighted that the strikes had led to shorter waiting times and more streamlined operations. “Lower bed occupancy improves flow, and with that the patient experience,” said Dr Damian Roland from the University of Leicester, referring to the hospital term for the timely movement of patients through the system. However, he also warned that this efficiency relied on consultants taking on frontline roles, which is not a long-term strategy.
“The more doctors involved in a patient pathway, the longer everything takes,”
explained Roland, emphasizing that junior doctors in training often require additional layers of senior input. This can delay care, but during strikes, consultants’ direct involvement appears to offset that issue. Dr Layla McCay, representing NHS trusts through the NHS Alliance, acknowledged the benefit but stressed that the approach is unsustainable. “This is a temporary solution with knock-on effects,” she said, noting that while consultant presence improves decision-making, it leaves a gap in training the next generation of medical professionals.
Some hospitals have experimented with new protocols on non-strike days. For instance, one trust now places cardiology consultants at the emergency department’s entrance every Friday, inspired by the strike’s impact. Nick Hulme, former chief executive of East Suffolk and North Essex NHS Foundation Trust, described the tactic as “a smart way to reduce admissions ahead of the weekend,” as consultants are less likely to admit patients with chest pain compared to trainees.
The December strike accelerated the pre-Christmas goal of discharging patients to ease the festive period’s strain. NHS England confirmed that thousands of patients were safely sent home, despite the walkout. While these results suggest potential benefits, the challenge remains: can such disruptions be maintained without compromising the development of resident doctors? The BMA’s Dr Jack Fletcher warned that the retirement of current consultants could leave a void if trainees continue to leave due to low pay and poor working conditions.
