Hospital trusts are taking determined measures to restrict the expected lack of life from this week’s NHS strikes – together with threatening consultants who refuse to do further work, and tempting junior docs to cross picket strains by growing locum pay – as fears grows that many wards might be left with out medical cowl.

NHS leaders and senior clinicians concern the four-day walkout by junior docs – beginning at 6.59am on Tuesday and persevering with till 6.59am on Saturday – will result in the cancellation of a whole lot of hundreds of operations and appointments, whereas placing critically in poor health sufferers at larger threat.

Hospital trusts are additionally accelerating the discharge of the fittest sufferers and have cancelled go away for non-striking docs in an effort to plug the gaps attributable to tens of hundreds junior docs strolling out.

One senior advisor at a London belief instructed the Observer she had been threatened with not being paid if she refused to be redeployed into areas exterior her specialised subject. “There is a huge amount of bullying going on,” she stated. In London, many consultants are understood to be refusing to do further shifts in the course of the strike as a result of their trusts won’t supply the charges of pay advisable by the British Medical Association.

In order to tempt junior docs, whose pay might be as little as £14 an hour, rates for locums are additionally being elevated. One belief is providing these prepared to cross picket strains £86.22 per hour for locum night time shifts – 50% greater than its regular locum price, in line with a price card despatched to employees and posted on-line by the BMA.

Recruitment companies are additionally providing escalated pay to junior docs on the 4 strike days this week. Job advertisements from an company in Nottingham stated these prepared to work day shifts would rise up to £70 per hour, with the company charging its price to the NHS on high.

Junior doctors are asking for a 35% pay rise to “reverse the steep decline” they’ve confronted after years of below-inflation pay rises. The BMA says that since 2008/9, they’ve had a real-terms pay minimize of 26%, and they’re now searching for “full pay restoration”. They additionally wish to agree a mechanism to forestall future declines of their pay in opposition to the price of residing, and to reform the pay evaluation course of.

With lower than three days to go earlier than what’s broadly anticipated to be probably the most damaging strike in NHS historical past, the federal government and the BMA remained deadlocked final night time, with ministers refusing to make any supply on pay to the junior docs till they agreed to name off the strikes.

In a transparent try to show public opinion in opposition to the putting docs, a senior authorities supply claimed the BMA’s negotiators have been inexperienced and unimaginable to take care of, and accused it of getting an anti-government agenda. “They are not professional negotiators. They just want to bring the government down,” the supply stated.

The junior docs insist it’s as much as the well being secretary, Steve Barclay, to make them a “credible” supply. “We are ready to get round the table, so make a credible offer to start negotiations and stop the strikes,” the co-chairs of the BMA junior docs committee, Dr Vivek Trivedi and Dr Rob Laurenson, stated.

With as much as 1 / 4 of one million appointments and operations anticipated to be postponed, the NHS Confederation warned that “many aspects of patient care” have been “resting on a knife edge”. Dr Layla McCay, director of coverage, stated the economic motion was set to be “the most significant in a decade”.

Miriam Deakin, director of coverage at NHS Providers, stated employees had been working “flat out to discharge patients safely and minimise demand on pared-back frontline staff’’. “This is normal practice ahead of any bank holiday weekend, but the four-day junior doctors’ strike inevitably makes this task more urgent,” she stated.

Last week, Portsmouth Hospitals University NHS Trust was criticised after introducing a contest handing out Easter goodies to groups that discharged sufferers the quickest. The belief has since apologised, saying incentives had “no place” in influencing scientific choices.

The timing of the strikes has additional exacerbated the staffing pressures, with many consultants and non-striking docs who would possibly usually be drafted in not obtainable because of the Easter holidays. One belief stated it had cancelled all go away however was nonetheless more likely to have some wards with no medical cowl.

The chief government of one other NHS belief stated: “We are in the territory of asking already-tired people to consider cancelling their holiday and we pay for all of the abortive costs. Those with families almost certainly won’t, as they can’t rearrange out-of-school holidays.”

Last night time the Tory MP and former well being minister Dr Dan Poulter, who works half time as an NHS psychiatrist stated: “Both the BMA and the government need to drop hostilities and urgently get back round the negotiating table. The only losers from the current deadlock are patients and if matters are not resolved soon, the NHS will take years to recover.”

He added: “Given the high hourly rate of pay for consultants working extra hours to cover the strikes, and the eye-watering fees charged by medical locum agencies, hospital finances, which are often not well-managed by trust boards at the best of times, will be pushed further into the red. This will reduce the money available for patient services and for the NHS to reduce the ever-growing waiting lists caused by the Covid pandemic.”

In London, one belief warned sufferers of a “very challenging week ahead”, with a “double whammy” of strikes and the Easter Monday financial institution vacation anticipated to “ramp up pressures” at its hospitals.

Dr Richard Jennings, group chief medical officer for St George’s, Epsom and St Helier University Hospitals, stated that in the course of the first junior docs’ strike final month, a median of 330 docs have been absent throughout its group every day. This led to greater than 3,000 appointments being rescheduled and almost 500 sufferers being directed away from its emergency departments over the three days of motion. “The strikes had a significant impact on our services last month and we expect it to be as challenging – if not more so – this time round,” he stated.

The supply of short-term larger charges for junior docs prepared to work on strike days was criticised by a consultant of the British Medical Association, which says “fair rates” must be customary. Shivam Sharma, from the West Midlands BMA Regional Junior Doctor Committee, urged colleagues to “hold the line”.

Last night time Sir Stephen Powys, the NHS nationwide medical director, stated 4 days of strikes would trigger “unparalleled levels of disruption”. Powys stated he was “very concerned” in regards to the impression on sufferers, with hospitals dealing with almost 100 hours with out as much as half of their medical workforce. Up to 1 / 4 of one million appointments and operations might be postponed, the NHS Confederation stated.