• Daniel Furnivall, Alex Bottle, and Paul Aylin.
• Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.
• BMJ Open. 2018 Feb 8; 8 (1): e019319.

ObjectivesTo examine the impacts of the four episodes of industrial action by English junior doctors in early 2016.DesignDescriptive retrospective study of admitted patient care, accident and emergency (A&E) and outpatient activity in English hospitals.SettingAll hospitals across England.ParticipantsAll patients who attended A&E or outpatient appointments or those who were admitted to hospital during the 3-week period surrounding each of the four strikes (12 January, 10 February, 9-10 March and 26-27 April, excluding weekends).Main Outcome MeasuresRaw numbers and percentage changes of outpatient appointments and cancellations, A&E visits, admitted patients and all inhospital mortality on strike days compared with patient activity on the same weekday in the weeks before and after the strikes.ResultsThere were 3.4 million admissions, 27 million outpatient appointments and 3.4 million A&E attendances over the four 3-week periods analysed. Across the four strikes, there were 31 651 fewer admissions (-9.1%), 23 895 fewer A&E attendances (-6.8%) and 173 462 fewer outpatient appointments (-6.0%) than expected. Additionally, 101 109 more outpatient appointments were cancelled by hospitals than expected (+52%). The 26-27 April strike, where emergency services were also affected, showed the largest impacts on regular service. Mortality did not measurably increase on strike days. Regional analysis showed that services in the Yorkshire and the Humber region were disproportionately more affected by the industrial action.ConclusionsIndustrial action by junior doctors during early 2016 caused a significant impact on the provision of healthcare provided by English hospitals. We also observed regional variations in how these strikes affected providers.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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