Earlier this week, many thousands of NHS staff across England and Northern Ireland took part in a four hour strike in protest at the government’s refusal to implement the 1% pay rise for all NHS staff, as recommended by the independent review body on Doctors’ and Dentists’ Remuneration (DDRB). The action was not taken in Scotland, where the 1% rise recommended was implemented in full, or Wales, where trade unions accepted a two year pay deal.

Industrial action is typically viewed with trepidation among healthcare staff, whose instincts are to care for patients first and foremost.

But with unions citing a 15% cut in NHS staff wages since 2010, organisers of the action said that the government’s refusal to listen to the review body left them with no choice but to take this action.

As correspondent Adrian O’Dowd reports, staff from Unite, Unison, the GMB, and the Royal College of Midwives ensured the effect of the current action on patients was limited by maintaining emergency and urgent care cover during the four hour walkout.

Dave Prentis, Unison’s general secretary, summed up the delicate balance that healthcare workers face when taking industrial action. “NHS workers don’t go on strike lightly, but they do so carefully and safely,” he said. “Patient safety is paramount, and this is why workers stopped for just four hours.”

As O’Dowd highlights, neither the BMA nor the Royal College of Nursing was involved in the current dispute.

A look back at a head to head debate published by The BMJ in 2012, when the BMA voted to take industrial action in protest at changes to doctors’ pensions, demonstrates how divisive the issue can be. While Alan Robertson argued that well planned industrial action can ensure patient safety, Julian Bion countered that it damaged doctors’ professional reputation as well as compromising care.

Gareth Iacobucci is news reporter for The BMJ.