Hospital trusts are taking desperate measures to limit the predicted loss of life from this week’s NHS strikes – including threatening consultants who refuse to do extra work, and tempting junior doctors to cross picket lines by increasing locum pay – as fears grows that many wards could be left without medical cover. NHS leaders and senior clinicians fear the four-day walkout by junior doctors – starting at 6.59am on Tuesday and continuing until 6.59am on Saturday – will lead to the cancellation of hundreds of thousands of operations and appointments, while putting seriously ill patients at greater risk. Hospital trusts are also accelerating the discharge of the fittest patients and have cancelled leave for non-striking doctors in order to plug the gaps caused by tens of thousands junior doctors walking out. One senior consultant at a London trust told the Observer she had been threatened with not being paid if she refused to be redeployed into areas outside her specialised field. “There is a huge amount of bullying going on,” she said. In London, many consultants are understood to be refusing to do extra shifts during the strike because their trusts will not offer the rates of pay recommended by the British Medical Association. In order to tempt junior doctors, whose pay can be as low as £14 an hour, rates for locums are also being increased. One trust is offering those willing to cross picket lines £86.22 per hour for locum night shifts – 50% more than its normal locum rate, according to a rate card sent to staff and posted online by the BMA. Recruitment agencies are also offering escalated pay to junior doctors on the four strike days this week. Job ads from an agency in Nottingham said those willing to work day shifts would get up to £70 per hour, with the agency charging its fee to the NHS on top. Junior doctors are asking for a 35% pay rise to “reverse the steep decline” they have faced after years of below-inflation pay rises. The BMA says that since 2008/9, they have had a real-terms pay cut of 26%, and they are now seeking “full pay restoration”. They also want to agree a mechanism to prevent future declines of their pay against the cost of living, and to reform the pay review process. With less than three days to go before what is widely expected to be the most damaging strike in NHS history, the government and the BMA remained deadlocked last night, with ministers refusing to make any offer on pay to the junior doctors until they agreed to call off the strikes. In a clear attempt to turn public opinion against the striking doctors, a senior government source claimed the BMA’s negotiators were inexperienced and impossible to deal with, and accused it of having an anti-government agenda. “They are not professional negotiators. They just want to bring the government down,” the source said. The junior doctors insist it is up to the health secretary, Steve Barclay, to make them a “credible” offer. “We are ready to get round the table, so make a credible offer to start negotiations and stop the strikes,” the co-chairs of the BMA junior doctors committee, Dr Vivek Trivedi and Dr Rob Laurenson, said. With up to a quarter of a million appointments and operations expected to be postponed, the NHS Confederation warned that “many aspects of patient care” were “resting on a knife edge”. Dr Layla McCay, director of policy, said the industrial action was set to be “the most significant in a decade”. Miriam Deakin, director of policy at NHS Providers, said staff had been working “flat out to discharge patients safely and minimise demand on pared-back frontline staff’’. “This is normal practice ahead of any bank holiday weekend, but the four-day junior doctors’ strike inevitably makes this task more urgent,” she said. Last week, Portsmouth Hospitals University NHS Trust was criticised after introducing a competition handing out Easter chocolates to teams that discharged patients the quickest. The trust has since apologised, saying incentives had “no place” in influencing clinical decisions. The timing of the strikes has further exacerbated the staffing pressures, with many consultants and non-striking doctors who might normally be drafted in not available due to the Easter holidays. One trust said it had cancelled all leave but was still likely to have some wards with no medical cover. The chief executive of another NHS trust said: “We are in the territory of asking already-tired people to consider cancelling their holiday and we pay for all of the abortive costs. Those with families almost certainly won’t, as they can’t rearrange out-of-school holidays.” Last night the Tory MP and former health minister Dr Dan Poulter, who works part time as an NHS psychiatrist said: “Both the BMA and the government need to drop hostilities and urgently get back round the negotiating table. The only losers from the current deadlock are patients and if matters are not resolved soon, the NHS will take years to recover.” He added: “Given the high hourly rate of pay for consultants working extra hours to cover the strikes, and the eye-watering fees charged by medical locum agencies, hospital finances, which are often not well-managed by trust boards at the best of times, will be pushed further into the red. This will reduce the money available for patient services and for the NHS to reduce the ever-growing waiting lists caused by the Covid pandemic.” In London, one trust warned patients of a “very challenging week ahead”, with a “double whammy” of strikes and the Easter Monday bank holiday expected to “ramp up pressures” at its hospitals. Dr Richard Jennings, group chief medical officer for St George’s, Epsom and St Helier University Hospitals, said that during the first junior doctors’ strike last month, an average of 330 doctors were absent across its group each day. This led to more than 3,000 appointments being rescheduled and nearly 500 patients being directed away from its emergency departments over the three days of action. “The strikes had a significant impact on our services last month and we expect it to be as challenging – if not more so – this time round,” he said. The offer of short-term higher rates for junior doctors willing to work on strike days was criticised by a representative of the British Medical Association, which says “fair rates” should be standard. Shivam Sharma, from the West Midlands BMA Regional Junior Doctor Committee, urged colleagues to “hold the line”. Last night Sir Stephen Powys, the NHS national medical director, said four days of strikes would cause “unparalleled levels of disruption”. Powys said he was “very concerned” about the impact on patients, with hospitals facing nearly 100 hours without up to half of their medical workforce. Up to a quarter of a million appointments and operations could be postponed, the NHS Confederation said.