Publication reference: PRN02261
Sent via email, 16 November 2025

To:

• chief executives
• chief operating officers
• medical directors
• nurse directors
• communications leads

Dear colleague,

Having reached the halfway point of this latest round of industrial action by the BMA, I wanted to give you an update on how the NHS as a whole has been responding to the strike action.

Firstly, let me say a huge thank you to you and all your teams over the last couple of days – I know that there have been heroic efforts to maintain services through both the strike and Storm Claudia and early indications show that we are achieving our goal of delivering at least 95% of planned activity, with a number of trusts exceeding this. It’s a genuinely impressive response to everything you’ve had to contend with.

We still have a long way to go: not just in making sure we maintain delivery over the course of Monday and Tuesday, but planning really carefully to maintain services throughout November and December as the flu peaks and we get into the heights of winter. It’s going to require a real leadership effort to avoid any post-strike downturn in performance in the coming weeks and we will need to take extra care of each other – especially our frontline teams who really feel the brunt of the pressure.

A big part of this will be keeping our colleagues healthy, so please continue this year’s very positive push to get as many staff and patients vaccinated against the flu as possible, particularly given recent UK Health Security Agency (UKHSA) data is indicating good effectiveness of this year’s vaccine against circulating strains.

While turnout is variable across the country, there are some really encouraging early indications that there have been fewer resident doctors striking than in any of the previous 12 rounds of industrial action. There will be many factors behind this, but it underscores the importance of trust chief executive officer’s (CEOs) and medical directors meeting with local Rapid Diagnostic Centres (RDCs) to work through delivery of the 10 Point Plan.

All of this is really encouraging and down to the continued hard work and efforts of you and your teams. We mustn’t become complacent and there is some really hard work directly ahead of us – but don’t lose sight of how remarkable the NHS response to all of this has been.

Get in touch if there is anything you need. Keep going…

Sir James Mackey
Chief Executive, NHS England