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Hospital doctors and GPs are taking industrial action on Thursday in protest at the government pushing through changes to their pensions that they regard both as unfair and unnecessary.
The government has claimed that up to 30,000 operations could be cancelled and 1.25m GP appointments postponed as a result of the strike, which was due to start at midnight. The figures cannot be verified as the Department of Health has asked NHS trusts not to reveal details to the media.
The action has been preceded by a war of words between doctors' leaders and ministers, with the health secretary, Andrew Lansley, suggesting on Wednesday that the strikes were "useless" and would not be supported by patients.
Not all doctors are taking part in the action. About a third do not belong to the British Medical Association, which has called the action.
And when the BMA balloted its members last month, 21% of GPs and 15.7% of hospital consultants said they were not prepared to participate.
Given the turnouts were 53.1% and 56% respectively, that suggests many doctors are unlikely to join in. But services in both hospitals and GP surgeries in many areas will be affected.
Doctors will not be picketing their own workplaces. Unlike other industrial disputes, they will still attend their hospital or surgery as usual.
Even doctors taking part in the action will continue to deal with urgent and emergency cases, so it should be business as usual in A&E departments, maternity units, for renal (kidney) and cancer patients, and anyone needing an urgent diagnostic test or end-of-life care.
However, they will not undertake routine duties, and some GP surgeries have postponed a number of pre-booked routine appointments due on Thursday, including non-urgent consultations and monitoring of long-term conditions.
GPs will deal with urgent prescription requests but not repeat prescription requests, and will still review test results and refer any abnormal ones to hospital.
The strike is also why an estimated 80% of UK hospitals – a BMA figure based on talking to local NHS managers about the action's likely impact – have cancelled at least some planned operations and some outpatient appointments.
Lansley has estimated that as well as the forecast 30,000 cancelled operations and 1.25m delayed GP appointments, "58,000 diagnostic tests may have to be postponed and over 200,000 outpatients appointments may have to be rescheduled".
There is no way of verifying these figures because the Department of Health, through its strategic health authorities around England, has asked NHS trusts not to release such details to the media, just as it did with the multiunion day of action over pensions last November. It may release a summary of what it claims the impact has been later on Thursday– a move which, last time it happened, some health professionals decried as media management.
"I don't have any hard numbers [of patients affected] but in some places it will be very disruptive and in other places it will be very minimal", said Dean Royles, director of NHS Employers, which represents hospital trust in England. Patients awaiting an operation to remove a cataract or benign lump, or replace a worn-out hip or knee, are among those whose care has been postponed, but only in some places, he said.
The amount of planned care postponed varies from one hospital to another. Health Service Journal reports that Wythenshawe hospital in Manchester, for example, is cancelling no operations but has rescheduled 15 outpatient appointments; University Hospital of North Staffordshire expects to cancel just three non-urgent operations and eight non-urgent outpatient appointments; Peterborough and Stamford Foundation Trust had postponed two operations and 53 outpatient appointment but thought that number might rise.
Michael Watson, director of advice and information services at the Patients Association said: "We've had calls to our helpline – though tens rather than the hundreds and hundreds we were expecting – from people who've had surgery or an appointment cancelled and told it's being rescheduled for another time. They include two older people who were due to have a hip and knee replacement respectively; a guy who'd been waiting three months to have his hearing tested at an audiology appointment, who's been told that it'll probably be another two months before he's seen again; and some general GP appointments.
"Those patients are frustrated because they waited to get these appointments and now they're going to have to wait longer. That's when you'll see the most anger, when people are told that their rescheduled appointment is one or two months away", he adds.
However, the NHS Confederation, which represents hospitals, said that patients whose operation is cancelled for non-clinical reasons at the last minute have to be offered another binding date within 28 days or have their treatment funded at a hospital of their choice.
The UK's 10,000 GP surgeries are likely to be less affected than hospitals. "All GP surgeries will be open but the majority will be unaffected by the industrial action and in the others they will be open and taking emergency calls", said Royles.
In Yorkshire, NHS Airedale, Bradford and Leeds says that, of its 81 GP surgeries, just 12 will see all GPs taking part in the action, with 20 other surgeries seeing some GPs take part, and the other 49 surgeries totally uninvolved. A snapshot survey by Pulse magazine on Tuesday suggested that as few as 22% of GP surgeries intended to join the action.
