To:

• Integrated care board and trust:
  • chief executives
  • chief operating officers
  • chairs
  • chief people officers/human resource (HR) directors
  • medical directors
  • directors of nursing
  • directors of communication

cc:

• Regional:
  • directors
  • performance and improvement directors
  • medical directors
  • directors of nursing
  • directors of workforce
  • deputy directors for emergency preparedness, resilience and response
  • directors of communication

Dear colleagues,

Planned industrial action by the British Medical Association – November 2025

Frustratingly, the British Medical Association (BMA) has confirmed their planned strikes for next week will go ahead from 7am on Friday 14 November to 7am on Wednesday 19 November 2025. There has been a huge effort to pull out all the stops with the BMA resident doctors committee over the last few weeks and generate an offer to avert strikes but, disappointingly, to no avail.

The last round of industrial action showed the NHS at its best: our collective effort minimised disruption of care for our patients because we were able to keep the majority of services operating. Thousands more patients were able to get the care they needed than would otherwise have been the case, thanks to your teams’ efforts.

The challenge heading into next week is to stretch ourselves to build and improve on that performance. This is not just important for maintaining the energy we created among our teams last time round, it is essential to our broader winter effort.

Data suggests that this season’s flu will be picking up just as we come out of this latest set of strikes. It is imperative that we plan our approach very carefully this time round to maintain a strong performance during the period of industrial action and in the weeks that follow. We’re in a marathon, not a sprint.

Preparing for industrial action

As we achieved last time, our objective is to maintain the level of service we provide to the public and keep patients safe. This means that we must have a laser focus on the following 4 priority areas:

• maintaining emergency care, including maternity services
• maintaining flow, ensuring appropriate and efficient discharge and length of stay
• maintaining elective care to the fullest extent possible – with at least 95% of elective activity continuing compared with what would otherwise have been expected
• maintaining priority treatments, including urgent elective surgery and cancer care

Reducing volumes of bookings, rescheduling appointments and other activity should only happen in exceptional circumstances to safeguard patient safety. This should be undertaken in consultation with your NHS England regional chief operating officer.

We proved last time that we could maintain a near-full programme of elective work, so we should maintain at least 95% of elective activity as a minimum requirement, although I know a growing number of you are targeting 100%.

Managing during the incident

An accompanying letter from Mike Prentice, National Incident Director, will set out the details of the processes for patient safety mitigations, data collection and guidance on training and redeployment.

On patient safety mitigations, we will absolutely maintain our approach that you and your clinical teams will decide where they are needed; you will be supported by the national team wherever you require it. 

Meghana Pandit has established a national clinical panel to review requests promptly, provide a clear and timely response where required, and escalate to the BMA. We expect the BMA to work with us constructively in considering these requests and to put patients’ needs first.

On data collection, clearly understanding the position in terms of staffing levels and the resulting impact on activity remains essential. Sitreps will be collected ahead of the industrial action period to assess where we are going into the incident. Once again, we will not ask you for submissions during the period, but as before, collecting post-action sitreps on both activity and staffing will be really important. It goes without saying that data quality, completeness and timely delivery are essential.

In addition to sitreps, we will be using real time mechanisms to closely monitor activity levels through the period from 12 to 20 November 2025, using the Acute Healthcare Operational Data Flow (HODF) collection (previously referred to as faster data flows data). Daily emails summarising your trust’s position, based on your HODF data, will be shared with you to provide confirmation that the information is accurate.

On the impact of taking strike action on training and redeployment, participating in industrial action counts as absence from training and may affect progression, triggering reviews if thresholds are exceeded. Therefore, all absences must be reported appropriately.

It is unacceptable for doctors participating in industrial action to take locum or bank shifts elsewhere, as this raises professionalism concerns. Where locum arrangements are legitimately being put in place, providers should not adopt the BMA’s rate card, or where this has been agreed previously, this should be re-evaluated. Pay rates are determined locally, and negotiating mechanisms through providers should be maintained.  You should work with your integrated care boards (ICBs) to share information and ensure that competition between neighbouring organisations does not occur. Rates should remain within the normal ranges and not be escalated due to industrial action.

On communications, we need to continue building on the robust approach your communications teams delivered last time around. The importance of making sure patients and communities are well informed about the NHS maintaining services ahead of next weekend, and that our staff have the information they need, cannot be overstated. In the week ahead, we should emphasise the progress you are making locally against the 10 Point Plan so that local resident doctors are informed of everything you are doing before they decide whether to join picket lines.

Recovering from industrial action

Because of the predicted spike in flu directly after this period of industrial action, and its proximity to peak winter pressures, we all need to approach these latest strikes with a view to not just optimising performance during the next couple of weeks but ensuring we plan to recover as effectively as possible over the subsequent weeks.

Your regional teams will maintain the support available to you throughout that extended period and will monitor real-time data to identify problems and help resolve any that arise. Given that we will soon be in the main winter period, this level of oversight and support may need to remain in place through to January 2026. We will take stock of this towards the end of November and discuss with you.

None of this is easy, and it’s important that, despite this disruption, we all maintain the same energy and commitment shown throughout this year in the various challenges we’ve faced. Keep up the good work, and let’s stay close over the weeks ahead.

Yours sincerely,

Jim Mackey, Chief Executive, NHS England