ENGLAND — Members of the British Medical Association staged a five-day walkout across England in December, the 15th strike in the long-running dispute over pay. About 25,000 doctors were absent from work each day during the strike, which was timed to run up to the start of the Christmas season, according to NHS England.

On strike days, planned operations and appointments were postponed. NHS England stated that 95% of routine treatment continued during the walkouts and reported that it had safely discharged thousands of patients home to their families ahead of Christmas despite the strike action.

Several hospitals reported faster emergency department performance during the strike. At the Royal Berkshire Hospital, 82% of cases met the four-hour A&E target during December's walkout, compared with 73% the previous week. At King's College Hospital, a study of the first junior doctor strikes in 2023 found that patients were seen, treated and discharged faster on strike days despite fewer staff on duty. Researchers reported no rise in deaths or readmissions during those earlier walkouts at King's College.

On routine non-strike days, emergency departments are mainly staffed by early-career doctors training for specialist roles who often order more tests and seek multiple layers of senior opinion. Consultants and other senior doctors deployed in A&E during strikes can assess more quickly whether patients need urgent treatment or can be safely redirected to other community health services. Dr. Layla McCay, director of policy at the NHS Alliance, said: "We have heard, anecdotally, that the enhanced presence of consultant colleagues in A&E, with their additional experience, can mean quicker, less risk-averse decision-making, which is good for patients. But this is a temporary, unsustainable solution with knock-on effects."

Dr. Damian Roland of the University of Leicester said decision-making tends to be more direct when consultants take over front-line roles during strikes. "Lower occupancy improves flow, and with that the patient experience," Roland said. Flow refers to the movement of patients from the emergency department to other parts of the hospital for treatment.

Nick Hulme, former chief executive at East Suffolk and North Essex NHS Foundation Trust, said that at one NHS trust, cardiology consultants are now placed at the emergency department entrance every Friday on non-strike days. "Junior doctors are more cautious," Hulme said. "After seeing the impact of the strikes, we realised this was a smart way to reduce admissions ahead of the weekend."

Resident doctors, formerly called junior doctors, make up nearly half of the medical workforce in the NHS. Senior doctors redeployed to front-line roles on strike days had to cancel other commitments, and premium rates for consultant cover can exceed £3,000 for a single night shift. A Freedom of Information request found that in 2023, consultant cover cost three times more than trusts saved in withheld junior doctor pay. The Nuffield Trust estimated the cost of industrial action at around £30 million per strike day, though the figure depends on turnout and time of year, while the government's estimate was £50 million per strike day.