We’re all now very used to doctors taking collective action – all of us have either been on strike ourselves or know colleagues who have taken action over the last 18+ months of the pay campaigns. Collective action is one of the most powerful tools in the trade union tool-box when used effectively.

Historically, most strikes have been local – a single factory’s workers, a local train depot’s crew, a shop’s staff. For doctors, though, all our formal strikes to date have been run at national level. There have been small-scale local rebellions of various kinds, but they’ve not been officially run by the BMA and they have had a variable success rate. I’m talking here about various kinds of action that might be described using quite strong-sounding trade union terminology: overtime bans, withdrawal of goodwill, working to rule, and so on.

So what happens when the BMA gets involved and supports local collective action? I’ve got three examples for you – the biggest of which is an ongoing, evolving situation that’s worth your time following on social media. All involve doctors taking action to demand improvement to rates of pay for extracontractual work – locum/bank shifts mainly – that had stagnated or actually been cut.

Strength in numbers

The first example is from my own trust, Imperial. Our weekday rates for anaesthetists taking extra sessions hadn’t gone up since 2009, and then this year the trust rather boldly decided to cut the rates on offer, sparking outrage.

We’d previously had some unsuccessful attempts within anaesthetics to withhold additional shifts (extracontractual work) as the rates were being eroded by inflation. However, they weren’t well-coordinated, so only a few people took part and it failed.

This time, we organised.

BMA members went round talking to everyone in the department in a structured way, with a spreadsheet to track things. We talked to them about how we could win on this, and people eagerly signed up to the pledge to either fully withhold or to halve their extracontractual work until the rates went up. We set a threshold – no-one’s names would be made public until we had 50% of the department signed up, so people would know they were not in a minority. Within a few days we had more than half the anaesthetic department on board, and we notified management we’d like to talk.

The trust tried reverting the rates back to what they had been before, but that wasn’t going to wash. The doctors honoured any already-agreed shifts, but within a few weeks the rota looked increasingly red and painful as hardly any new shifts were filled.

There were several meetings with senior managers, including the MD and chief exec, but no significant increases were offered. There was talk about bullying or coercion, and various small increases were unilaterally implemented by the trust to try to break our resolve. We’d talked to the anaesthetists about all the possible things that might be tried, so no-one wavered – the team had been successfully inoculated against management tactics.

In the end, after just under three months of underfilled rotas, the trust agreed to a 50% uplift for the weekday rates, and a 23% increase for weekend lists, for both surgeons and anaesthetists. This was accepted, with 90% of the doctors voting in favour.

How had people found it? Roughly the same number, 87%, said they’d be willing to take this form of action again if needed, too. It helped that we had just had some back pay from the national pay campaign to tide us over, and the half/full cessation pledge meant more people could participate even if they couldn’t afford to completely stop topping up their salaries.

Pressure on management

Chelsea and Westminster Hospital’s anaesthetists did much the same thing, at almost the same time. They dealt with management more formally, submitting a group claim; the organising of the doctors was done with two large meetings rather than dozens of one-on-one conversations, bolstered by WhatsApp group discussions.

There were some attempts to strong-arm things from the trust senior management, but the shared conversations meant the doctors stood firm. In the end, they won a similar increase to Imperial’s – and not by coincidence, as the BMA reps from each trust were in touch with each other (as were their respective management teams!).

The third example is a live one you may have seen on social media. Managers at University Hospitals Birmingham (UHB) have recently tried to drop their extracontractual rates (a common theme) and the doctors there are obviously angry. They have had an open meeting to which hundreds of doctors came at short notice. A survey sent out to all BMA members at UHB last week had nearly two thirds of them responding within 48 hours, with virtually all saying they were prepared to take action – including refusing to take additional extracontractual shifts.

Already the trust has backed down on its attempt to cut the rates, and there is a trust-wide meeting of BMA members next week.

Backed by BMA resources

For campaigns like these to succeed, the issue has to be widely felt (by a large number of people), deeply felt (the affected people really have to care about it), and winnable (with achievable demands). These disputes all tick those boxes, hence the strong responses of the doctors coming together so well.

Local campaigns are something the BMA will be doing a lot more of. We’ve allocated significant resources to support activity at local level, with a lot planned in particular for training staff and local reps in how to organise for success. The strike fund remains available for local disputes if needed, and the BMA’s renewed strategy document puts local action at the heart of what we are doing, alongside the national campaigns on pay and other issues.

If you have an issue locally that you want to campaign about, contact your local negotiating committee (find your LNC) and start planning the campaign together. If you’re on your LNC already and want more support on a campaign, your industrial relations officer will help you get what you need. If your campaign is going to be something big and you want more central support, the BMA’s trade dispute preparedness group (TDPG) may be able to help. For the latter, email me or Emma Runswick, deputy chair of UK council, to see what the TDPG can do with you.

Things that management used to get away with locally, they will find a lot harder to impose in future. Our strength comes from standing together, whether across the country or across a department. You are your union!

Tom Dolphin is a member of the BMA’s UK council and a consultant anaesthetist in London