The "day of action" called by the British Medical Association tomorrow in their pensions dispute with the Government looks like turning into a day of confusion. More than 35 years after their last strike in 1975, the BMA's 100,000 members are facing public outrage over their decision to withdraw their labour over what most patients see as already generous pension arrangements.
The outrage, extending to formerly doctor-friendly newspapers, appears to be having an impact. Doctors are increasingly divided about whether to support the action (which they insist is not a "strike"); employers are unclear about whether to pay their wages on the day; and patients are confused about which services will be available.
BMA leaders are worrying over what to do for a follow-up and ministers are debating how to maintain their hardline refusal to reopen negotiations, while providing the association with a dignified way out of the impasse.
The level of confusion is reflected in reports that a number of trusts will not be docking the pay of striking doctors because of the difficulty of calculating how much to deduct. Is a doctor who carries out urgent and emergency care – as all must or risk losing their licence to practice – working or not? An added complication is that GPs are self-employed, so do not have a fixed daily rate.
Ministers warn that more than one million appointments, tests and operations scheduled for tomorrow will have to be postponed and rearranged. Andrew Lansley, the Health Secretary, has suggested doctors work an extra day next Saturday to catch up with the backlog, a proposal ignored by the BMA.
However, the one million missed appointments is a worst case scenario. Indications are that the level of disruption will be much lower with perhaps as few as a quarter of doctors involved in the action. Figures obtained by the doctors' magazine Pulse from 20 primary care organisations show just 281 out of 1,265 practices (22 per cent) have so far notified NHS managers they will be taking action. In Buckinghamshire, Oxfordshire and Suffolk, almost two thirds of practices have confirmed they will be working normally. In Nottinghamshire, where just 28 of 161 practices (17 per cent) have said they will be taking action, Dr Greg Place, chair of the local BMA commitee, said despite doctors' "steaming fury" over the pensions issue, they were worried the action could backfire.
"We will have to do everything we don't do on Thursday on Wednesday and Friday instead. The only people who will suffer are us."
Among hospitals, a similarly low response is expected. At a meeting last week attended by managers from over 100 NHS trusts, less than a quarter said they expected patient care to be affected, according to the NHS Confederation.
The BMA has pledged that all hospitals and GP surgeries will remain open, "urgent" and "emergency" cases will be seen, and doctors will be at work. But in surgeries and hospitals where doctors are taking action, routine appointments, operations and non-urgent tests will be postponed. The difficulty will be distinguishing the two. The best advice to those who want to ensure they are seen on the day is to insist the problem cannot wait.
The BMA, which represents two thirds of Britain's 144,000 doctors, claims support for the strike was overwhelming – 85 per cent of those who voted – on a "very high" turnout. But only half of doctors voted in the ballot and one in eight of those were against.
The strike is over changes to pensions which will see doctors pay more and retire later. A doctor currently earning £120,000 a year can expect to retire at 60 on an annual pension of £48,000, with a £140,000 lump sum. In future, junior doctors will have to wait till 68 to retire (the new state pension age) on a pension of £68,000 a year but will have to pay an extra £200,000 in contributions over their career, according to the BMA.
Their grievance is that the Government is reneging on a deal reached in 2008 and the current arrangements are delivering a £2bn surplus to the Treasury. Ministers counter that the world has changed, doctors are living longer and comparable workers in the private sector would require a pension pot of £2 m for the same retirement income. They say the £2bn surplus will only apply for a few years and will then move into deficit as more doctors retire.
Case study: I feel I am being bullied and intimidated
Dr Bill Beeby is a GP at Parkway Medical Centre in Middlesbrough
The reason I am taking part is because I feel we have been treated unfairly in relation to our pensions.
We had an agreement in 2008 with the Government, at which time most of us as doctors paid more. We knew the pension age was changed and many other factors were altered.
There was an agreement that this scheme would continue to be reviewed in the future and if there were signs that the pension scheme was not able to pay for itself it would be reviewed.
So it is particularly disappointing at a time when the pension scheme is in significant surplus that the Government has torn up our agreement. It is particularly galling that they are using the excuse that public-sector pensions are in deficit because ours is not. We are aggrieved that we are being asked to pay considerably more.
On Thursday, my surgery will be open and anyone who has an ailment that in their opinion is urgent will be seen by a doctor. We will not be doing routine appointments. Rather than having a booked surgery, we will have an open surgery.
This has been a difficult decision for me. It is now 35 years since I qualified and it is extremely unusual for me to even be thinking about any action. I took this decision with great reluctance. But I find myself in a situation where I feel I am being bullied and intimidated by the Government and I wish to exercise my right of reply.
Case study: This action shows how unhappy doctors are
Dr Beth McCarron-Nash, 39, is a GP in St Columb Major, Cornwall
I am taking this action extremely reluctantly. But the Government has broken the deal, they have broken the trust of the profession. In 2008 the NHS pension scheme was given a radical overhaul. Doctors already agreed new entrants would work to 65 and that we would pay more to subsidise lower-paid workers in the NHS.
Four years later the Government have ripped up that agreement and imposed measures that we think are particularly unjustified.
The contributions doctors make is twice as much as civil servants on a comparable salary. What we do not understand is why doctors are being made to pay more?
On Thursday I will see anyone who feels unwell and thinks that it is urgent. I came into medicine to treat patients. Our dispute is not with patients and I am sorry that patients will be inconvenienced on Thursday. It shows how unhappy the medical profession is to even consider taking this action.
Q&A: How you will be affected
Q Will hospitals and GP surgeries close tomorrow?
A No. They will remain open. Urgent and emergency care will be provided but non-urgent operations and appointments may be postponed.
Q Will I be able to get a GP appointment?
A Yes, so long as you say the problem is urgent.
Q What about operations and hospital outpatient appointments?
A The same applies. The hospital should inform you if your operation or appointment is affected. If you haven't heard, phone to check.
Q What if I have cancer?
A Cancer patients are promised treatment, such as chemotherapy, will proceed as normal.
Q What if I am pregnant and about to go into labour?
A Labour wards will be unaffected by the action.
Q What if I am waiting for a prescription or test result?
A Doctors will review test results, act on any found to be abnormal, and issue urgent prescriptions as normal.
Q What will happen to hospital waiting lists following the action?
A They may rise.