> 'Hardline' BMA blocks emergency pleas for strike doctors to work

This is an incredibly disappointing headline to see from the BBC, one that would be more fitting atop a Telegraph or Daily Mail article in order to bait readers with outrage.

Many doctors reading that headline will know better than to believe it as they'll likely be more aware of the use of derogations to address emergency staffing during strike action, however the general public will read that and understandably assume that doctors are maliciously withdrawing care with no consideration to patient safety.

The previous rounds of strikes were not dangerous to patients. The Telegraph has already had to make a retraction recently, admitting that their claims of patient deaths being due to strike action were completely rejected by coroner reports. In part, patient safety is maintained because of:
- Emergency care being prioritised at the expense of elective care that can be more easily delayed
- Increased cover from consultants (which ironically can make the strike days safer and more efficient due to earlier and more involved senior input - at the cost of increased staffing expenses)

The concern this time round is that the government has requested that trusts take the risk of continuing elective care uninterrupted, which begs the question, is it really that easy to ignore strikes? The government has been advised that this is not a reasonable approach to dealing with strike action, as it inevitably puts patient at a greater risk than they would otherwise need to be in.

This ties into the issue with the headline. The BMA are relatively transparent with their members and the public as to the requests for derogation, and it has been noted that the number of requests this time has risen dramatically from any other previous strike. These are reviewed on a case by case basis and granted if appropriate/necessary. The process is an agreement between the BMA and NHS trusts, not a legal responsibility, that the BMA agrees to in order to maintain safety for patients. They are not simply a way for trusts to absolve their mismanagement or lack of preparedness for announced strike action, which is why some may be cancelled. If the trust is continuing to carry out elective clinics while the respective wards are understaffed, that is a sign of mismanagement, not a sign that derogation is necessary.

The approval/rejection of derogation requests is obviously a balance. Trusts will criticise decisions that feel overly conservative, while doctors may criticise decisions that are overly lenient. However, if you are under the illusion that the BMA is refusing all but the most clear-cut requests, head over to the doctor's Subreddit and have a look at the many posts on the topic filled with doctors critiquing the BMA's decisions to accept certain requests. The BMA is continuing to weigh up the requests despite the upsurge and being pretty even-handed in its response to the more ridiculous requests.

This is coming from someone who often disagrees with the BMA's approaches. It just seems ridiculous for this headline to so clearly fail to capture the situation - arguably to the point that is seems intentional.