NHS England is accelerating plans to reduce its reliance on resident doctors, as ongoing industrial action forces leaders to rethink how care is delivered across the health service. Sir Jim Mackey, chief executive of NHS England, confirmed in March 2026 that the organisation is actively developing new clinical models designed to maintain service continuity during repeated strike action, marking a significant shift in workforce strategy.
Strike disruption drives structural change
The move comes amid continued industrial action by resident doctors, organised by the British Medical Association, which has already led to widespread cancellations and service disruption since 2023. Mackey indicated that the NHS cannot remain as vulnerable to workforce withdrawal as it has been during recent strikes. Instead, the system must become more resilient by redesigning care pathways and redistributing clinical responsibilities.
This includes exploring ways to ensure that essential services can continue even when large numbers of junior doctors are absent, particularly in high-pressure areas such as emergency care and elective surgery. While NHS leaders emphasise that doctors will remain central to care delivery, the aim is to reduce dependency on any single workforce group.
Expanding multidisciplinary roles
A core component of the new approach is the expansion of multidisciplinary teams, with greater use of advanced practitioners, nurses, pharmacists and allied health professionals. Roles such as physician associates and advanced clinical practitioners are expected to take on more responsibility in patient assessment, routine care and service coordination. These staff groups have already been deployed in some areas to help manage demand during strike periods.
Mackey suggested that the NHS must “design services differently”, making better use of the full clinical workforce rather than relying heavily on traditional doctor-led models. This reflects a longer-term trend within the NHS towards skill-mix optimisation, where tasks are distributed across teams based on capability rather than professional hierarchy. However, the approach remains controversial, with some clinicians raising concerns about training, supervision and patient safety, particularly if role expansion is implemented rapidly.
Technology as an enabler of new care models
From a health technology perspective, digital tools are expected to play a key role in supporting these redesigned models of care. The NHS has already invested in electronic patient records, clinical decision support systems and remote monitoring technologies, all of which can help standardise care and reduce reliance on individual clinicians. For example, decision support tools can guide less specialised staff through clinical pathways, while digital triage systems can prioritise patients and allocate resources more efficiently.
Automation and AI are also being explored as a means of reducing administrative burden, freeing up clinical time and enabling staff to focus on direct patient care. However, experts caution that technology is not a substitute for clinical expertise. While digital systems can enhance productivity and consistency, they must be implemented alongside robust training and governance frameworks.
Balancing resilience with workforce morale
The strategy has significant implications for workforce relations. The British Medical Association has argued that reducing reliance on doctors risks undermining the profession and could exacerbate retention challenges. Doctors’ leaders have emphasised that strike action is driven by long-standing concerns over pay, workload and working conditions, and have called for meaningful negotiation rather than structural workarounds.
There are also concerns that shifting responsibilities onto other staff groups could increase pressure elsewhere in the system, particularly if workforce shortages persist across multiple professions. For NHS leaders, the challenge will be to balance the need for operational resilience with maintaining morale and trust among clinical staff.
A broader shift in NHS workforce strategy
Mackey’s comments reflect a wider shift in how the NHS is approaching workforce planning. Rather than focusing solely on increasing doctor numbers, there is growing emphasis on flexibility, productivity and system resilience. This includes redesigning services to better match patient demand, improving workforce deployment and leveraging technology to support care delivery.
The approach aligns with broader government priorities to improve NHS productivity without relying exclusively on increased funding. However, analysts note that such transformation will take time. Developing new care models, training staff and embedding digital systems across the NHS is a complex, multi-year process.
A system adapting under pressure
The move to reduce reliance on resident doctors highlights how industrial action is driving structural change within the NHS. While the immediate goal is to mitigate disruption, the longer-term impact could be a more flexible and diversified workforce model, one less dependent on traditional hierarchies and better able to adapt to changing conditions.
Yet the risks are equally clear. Without careful implementation, the strategy could strain other parts of the workforce and deepen tensions with doctors. As the NHS continues to navigate industrial disputes and rising demand, the success of these reforms will depend on whether they can deliver resilience without compromising quality of care, or the confidence of the workforce delivering it.
