Junior doctors across England will launch a four-day strike on Tuesday in a worsening dispute over pay, with fears it is set to be the most disruptive walkout in NHS history.
Here’s everything you need to know.
What is happening?
An estimated 250,000 appointments, including operations, will be cancelled as a result of the walkout by members of the British Medical Association (BMA).
Doctors will mount picket lines outside hospitals from 7am until Saturday morning in the longest stoppage of the wave of unrest which has seen nurses, ambulance crews and other health workers take action since last year.
It follows on the back a four-day bank holiday weekend when demand will have piled up. Managers have warned that patient care is “on a knife edge” because of the strike.
This strike is likely to be more disruptive than the 72-hour walkouts by NHS staff last month, which led to 175,000 cancelled appointments. Chief executive of the NHS Confederation Matthew Taylor has warned the strikes could be “catastrophic”.
Why are they going on strike?
Junior doctors – who can have many years’ experience and make up about 45% of the medical workforce – are locked in an increasingly bitter row over pay as the workload and patient waiting lists for treatment are at record highs.
With inflation ballooning above 10% and spikes in food and heating costs, wages have fallen in real terms and people have struggled to pay bills.
The BMA has asked for a 35% pay rise to bring junior doctor pay back to 2008 levels. They have voted overwhelmingly – 98% on a 77% turnout – to strike.
Health secretary Steve Barclay has said the doctors’ demand is “unrealistic” and said strikes had been planned to “cause maximum disruption”. The Department of Health has insisted that strikes be called off before negotiations can take place.
While some unions across the public sector have reached agreements with the government, many others have not. Teachers recently rejected a pay raise offer and nurses are still voting on a deal offered last month.
How much are they paid?
BMA officials said the pay issue is making it harder to recruit and retain junior doctors.
Newly qualified medics earn just over £14 an hour, the BMA said, and fresh advertisements by the union show how “little” junior doctors are paid for their roles in surgical procedures. It emphasises they are often anything but junior in skill and expertise.
Three doctors with 10, seven and one-years experience are pictured in an operating theatre where an appendix is being removed, one of thousands of similar operations that takes place every day in England.
For the procedure, which lasts about an hour, they would earn £28, £24.46, and £14.09 respectively, a total of just £66.55 for a potentially life-saving procedure, said the BMA, which has estimated that the pay of junior doctors has fallen by 26% in real terms over the past 15 years.
What should you do if you have an appointment?
On Sunday, national medical director of NHS England Professor Sir Stephen Powis said the strikes will put “immense pressures” on staff and services.
NHS England said staff will be asked to prioritise emergency and urgent care over some routine appointments and procedures to ensure safe care for those in life-threatening situations.
The health body said appointments and operations will only be cancelled “where unavoidable” and patients will be offered alternative dates as soon as possible.
The Department of Health says people should attend appointments unless told otherwise by the NHS, continue to call 999 in a life-threatening emergency and use NHS 111 online services for non-urgent health needs.
What do doctors say?
Dr Jennifer Barclay, a surgical doctor in the North West, said: “There is nothing ‘junior’ about the work I have done as a doctor.
“I’ll be trying to focus on steady, controlled hand movements, thinking about the next steps and communicating with the rest of the team.
“Meanwhile, my bleep is going off incessantly in the background with more and more patients waiting to be seen as soon as I get out of theatre.
“For that hour of work that might save a life I can be paid £19.
“I’ll be working a busy on-call shift; treating unwell patients, assessing new patients, consenting and preparing patients for surgery and answering never ending bleeps, when we have to run to theatre.
“I haven’t had time to eat or nip to the loo and I know I’ll be in theatre for around an hour.
“An appendicectomy like the one in this advert would be a typical case.
“I want the doctors treating my loved ones to be well rested and able to provide the best care possible.
“I don’t want them to be burnt out, worried about paying the bills or up to £100,000 of debt or thinking about alternative careers whilst making life and death decisions.
“My dad, an electrician, tells me to quit and retrain in his footsteps; I’d be earning more, have less stress, less responsibility, better hours and a better work-life balance after three years.
“Surely, this life, the training, responsibility, debt and crushing workload is worth more than £19 per hour?
“I’ll be on the picket line this week because doctors believe that it is.”
What does the government say?
Barclay said: “It is extremely disappointing the BMA has called strike action for four consecutive days.
“Not only will the walkouts risk patient safety, but they have also been timed to maximise disruption after the Easter break.
“I hoped to begin formal pay negotiations with the BMA last month but its demand for a 35% pay rise is unreasonable – it would result in some junior doctors receiving a pay rise of over £20,000.
“If the BMA is willing to move significantly from this position and cancel strikes we can resume confidential talks and find a way forward, as we have done with other unions.”