To: chief executives and medical directors

Date: 23 July 2025

Dear Colleagues,

You will be aware that the British Medical Association (BMA) has notified NHS England that, following a ballot, resident doctors will be taking strike action between 07.00 on Friday 25 July and 07.00 on Wednesday 30 July 2025.

NHS England wishes to ensure that, while resident doctors are taking lawful industrial action, patients remain safe. We know how disruptive strike action can be and we also know the serious consequences of large-scale elective cancellations — for patients, staff morale, and system recovery. We must not repeat the mistakes of previous rounds of action so we have worked hard to put in place a more robust, clinically grounded, and system-empowering model this time.

We acknowledge that, despite the comprehensive contingency plans being put in place, there may still be circumstances where mitigations are insufficient, and there is a need to request resident doctors to return to work for a limited period in order to maintain safe patient care. This letter sets out our arrangements for recalling staff in such situations.

We are therefore writing to set out the arrangements for asking a group of resident doctors to return to work during this period of industrial action in the event of the above occurring. This measure is not in place to avoid disruption caused by strike action; however, it is to ensure that in unexpected and extreme circumstances patients will continue to receive safe care. This measure is designed to be responsive to patient safety concerns arising during strike action rather than pre-empting impacts of strike action. Therefore requests for derogations should not be submitted until strike action has commenced and the risk to safety is present. 

A clear, clinically-led approach

This approach has been shaped to support local clinical leadership, provide clarity, and ensure decisions remain focused on patient safety and risk.

Derogations will be considered for

• major incidents
• urgent and emergency care
• P1 and P2 time critical treatment, where delay would risk clinical harm
• all essential cancer care at any point in the patient pathway
• time-critical interventions; for example, elective caesarean sections

We are not seeking derogations for routine elective care — but we expect systems to preserve delivery wherever safe and feasible, based on patient need and clinical risk.

Strengthened local decision-making

We are asking systems to resolve derogation issues locally wherever possible. Where agreement cannot be reached, the following clinical escalation route should be followed:

1. Clinical director of the relevant service
2. Trust medical director
3. Regional medical director

Only after this process has been fully followed will a request be considered nationally — and if appropriate, escalated to the BMA. This ensures national decisions are well-evidenced and clinically justified.

To support this, we have a national multidisciplinary team on hand to review requests promptly and provide a clear and timely response where required.

Empowering clinical leadership

This approach is designed to empower local clinical leaders. Trust medical directors — supported by regional medical directors — are best placed to make judgements about what can safely proceed. Our role nationally is to support you, not override your decisions. This is the model we are working to: clinically led, locally driven, and focused on patients.

A streamlined derogation request form is included with this communication to reduce administrative burden and enable timely decision-making. Once the BMA has approved a derogation, a local trust may contact resident doctors and seek their return to work.

Resident doctors on strike need not return to work unless the need for derogations is confirmed by the BMA. That being said: NHS England and the BMA recognise it may be necessary, as an exception, for a trust to contact resident doctors in the event of a mass casualty event, explaining the situation and seeking their return to work, while simultaneously escalating the situation as described above.

Thank you for your continued leadership. Please share this with your teams, and don’t hesitate to reach out to your regional colleagues or the national team for support.

Regards,

Prof Tim Briggs
NHS England National Director for Clinical Improvement and Elective Recovery

Sarah-Jane Marsh CBE
National Director of Urgent and Emergency Care and Operations

Publication reference: PRN02106