One of Norfolk's main hospitals is facing mutiny from its consultants who say they will no longer cover for striking junior doctors.
In a letter to leaders at the James Paget University Hospital in Gorleston, 69 of its consultants have accused bosses of breaching their contracts over redeploying them during industrial action by their colleagues.
They say that unless the hospital agrees to offer more cash for them to do so they will no longer be offering what they describe as "extra-contractual work" during junior doctor strikes, the latest of which began yesterday and ends at 7am on Tuesday.
Throughout the ongoing NHS strikes, thousands of patients have seen their care delayed, waits extended and appointments postponed.
To minimise this disruption, hospitals have been asking consultants to "act down" - a term used in the NHS when consultants do tasks that would ordinarily be performed by less senior staff.
However, the 69 signees of the letter - seen by this newspaper - say they will no longer agree to do this unless the hospital offers them extra money to do so.
The letter reads: "Going forward, we the undersigned, will not be able to offer any extra-contractual work, including waiting list initiatives and acting down, during foreseen staff shortages such as industrial action, unless JPUH is prepared to offer the British Medical Association rates, as is the case in many trusts around the country.
"In order to begin restoring trust and confidence in the executive team, we request that those that did undertake such extra-contractual work during the most recent period of industrial action are remunerated in line with BMA rates."
Currently, BMA rates call for consultants doing additional shifts to be paid up to £262 per hour - depending on when their additional shift has taken place.
The letter also claims the hospital had attempted to prevent staff from "SPA time" - which is time that consultants have built into their working patterns for training and career development.
It adds: "Prompt resolution of this issue is our hope and vital for the ongoing care of our patients.
"We are convinced that the requested rates for extra-contractual work are fair and reasonable."
A spokesman for the James Paget said: "Extensive planning has taken place ahead of the latest round of industrial action, with a focus on maintaining emergency care.
"This has involved close working with our clinical staff and partners in the Norfolk and Waveney healthcare system, so that we can continue to see and treat patients with the greatest clinical need."
It comes as consultants themselves prepare to strike later this month, with a two-day action planned for August 24 and 25.
Both sets of strikes are largely centred around pay, with union members voting to refuse a 6pc pay increase offered by the government.
The most recent junior doctor strike, between July 13 and 18, saw more than 12,000 hospital appointments in the east cancelled.
Edward Morris, regional medical director for NHS England in the East of England, said: "With every strike day lost, we see an increase in the backlog of essential NHS work and further pressure put on other staff across the region.
"Patients in need of emergency care should continue to come forward, but we fear thousands of appointments will be postponed again, and so urge the relevant parties to find a way to end this dispute once and for all."
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