More than 32,000 shifts, which should have been filled by doctors in hospitals across London, were not staffed over a six-month period in 2024, according to research undertaken by the BMA. 

Results from Freedom of Information (FOI) requests carried out by the BMA show that across 23 London trusts at least 32,576 shifts have been offered to doctors but have not been filled.  

Alongside this, the pay rates that London hospitals offer doctors to do extra shifts are capped lower than other parts of the country. The BMA believes trusts are colluding to keep the rates universally low across all sites and this means shifts are going unfilled as pay rates are not competitive enough and often worse than those offered outside of the capital.

The BMA is warning that the large number of unfilled shifts across London trusts is unsustainable and is having a detrimental impact on patient care and on the remaining doctors who are working in increasingly understaffed and challenging shifts.

As one resident doctor working at a North London trust said: “It’s a complete nightmare – the doctors who are left working have to work at 150%, patients have to wait longer to be seen, and by the end of the shift doctors are running on fumes.

“I recently did a night shift where there were two spots on the rota they didn’t manage to fill, so only one registrar and one senior house officer, seeing new patients coming in through A&E overnight. We ended up having patients waiting all night to be seen, because both doctors were so overwhelmed by new incoming patients. When you have multiple night shifts like this in a row you end up working in a way you simply can’t sustain” 

The BMA  is campaigning to ‘scrap the cap;’ to stop a practice which is artificially supressing rates and keeps doctors in London paid less than in other parts of the country to work extra shifts. It argues that better and fair rates agreed through negotiation with the BMA, would attract doctors to take unfilled shifts and ensure safer and better care for patients.

London Resident doctor and co-chair of the BMA North Thames Regional Resident Doctors' Committee, Dr Shivam Sharma, who sent the Freedom of Information requests to all Trusts in London, said: 

“I sent these Freedom of Information requests so that we would have the data to back up what doctors in London already know: we are untenably short staffed. Every single one of those 32,000 unfilled shifts meant overworked doctors were left trying to do the work of multiple medics. Patients in London deserve doctors who can give them the time and energy they need.

“As doctors, we can see first-hand the impact of huge waiting lists and overcrowded A&E departments with patient being treated on corridors and it makes even more frustrating that trusts in London are dragging their heels on this.

“It’s only common sense that if trusts abandoned the medical rate cap and paid these shifts more competitively, as trusts in other parts of the country can do, we would see fewer rota gaps and better-staffed hospitals. We’re urging doctors across London to sign up to our campaign pledge and help us to scrap the cap.”   

The BMA has invited London NHS trusts to negotiations to agree fair rates for all extra work doctors do across the capital, but these calls have gone unanswered by London’s NHS Trusts.   

Doctors can join the Scrap the Cap campaign by signing up to the pledge and commit to stopping all extra contractual work if BMA London calls for it to support negotiations with London NHS trusts. 

Notes to editors

• Full details of the numbers of shifts unfilled at each London trust are available on request.
• Dr Sharma sent FOI requests to trusts in December 2024, asking "the number of doctor shifts that have gone unfilled, even after the shifts have been put out for locums in the last 6 months."
• Please note that North Middlesex University Hospital returned the number of shifts over three months instead of six and the Royal Free NHSFT gave the number of shifts 1 March – 30 November instead of the six months prior to the FOI being sent, as the other respondents did. 
• 24 trusts came back with the number of shifts, while 9 trusts could not or did not respond to the FOI.  
• These shifts are offered by hospitals when they are unable to fully staff their rotas safely with the contracted hours of their employed doctors. They are usually offered at a rate higher than many basic salaries’ hourly rates, to encourage doctors to work them.
• Trusts in London have agreed between themselves not to negotiate rates with doctors individually, or raise rates further when shifts go unfilled, due to the London-wide medical rate cap that Trusts have colluded on together for a number of years. This “medical rate cap” artificially suppresses these rates and makes it harder to fill some shifts.  In other parts of the country doctors negotiate rates with trusts directly, and trusts can raise rates when shifts are hard to fill, meaning many shifts outside of London are paid higher than shifts in London. The BMA says that if London shifts were paid better, trusts would be more able to find doctors prepared to fill the rotas, and patients in London would benefit from the safety of properly staffed shifts. 

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

For media enquiries please email [email protected] or call 020 7383 6448