A deep dive into the current situation in England as junior doctors continue the longest strike in NHS history due to ongoing pay disputes.

5 minute read

Junior doctors in England walked off the job on Wednesday at the start of a six-day strike over pay. The industrial action comes as talks between the British Medical Association (BMA) and the government broke down in early December. It is the longest strike in NHS history.

Junior doctors are medical school graduates with between one and nine years’ experience. They currently make up around half of doctors working in England.

The UK has been hit hard by strike action in recent years with rail workers, nurses, barristers, and ambulance workers among many professions staging walk-outs over pay and conditions.

This is the ninth round of strikes by junior doctors.

Why are junior doctors taking strike action?

With significant underfunding and staff shortages due to poor recruitment and retention, the pressure on junior doctors has never been greater. Add to that the spiralling cost of living, and, like many public sector workers, junior doctors have had enough.

Many junior doctors are facing burnout, while record numbers are leaving the NHS either to pursue alternative careers, or to work in the private sector or overseas.

The BMA’s website states that:

“While workload and waiting lists are at record highs, junior doctors’ pay has been cut by more than a quarter since 2008. A crippling cost-of-living crisis, burnout and well below inflation pay rises risk driving hard working doctors out of their profession at a time when we need them more than ever. If junior doctors are forced out of the NHS because of poor pay and conditions, the services we all rely on to look after our loved ones will suffer.”

What does the strike hope to achieve?

According to the BMA, the strike action aims to:

• Achieve full pay restoration to reverse the steep decline in pay faced by junior doctors since 2008/09

• Agree on a mechanism with the Government to prevent any future declines against the cost of living and inflation

• Reform the DDRB (Doctors’ and Dentists’ Review Body) process, so pay increases can be recommended independently and fairly to safeguard the recruitment and retention of junior doctors

Pay restoration

Rather than a pay rise, the BMA uses the term “pay restoration” stating that pay for junior doctors has fallen by 26% since 2008/09 once inflation is taken into account. The BMA is asking for a pay increase of 35% to make up for its calculated loss of earnings since 2009.

Prevent future declines against the cost of living and inflation

The BMA is asking for measures to be put in place to protect doctors from future real-term pay cuts due to inflation and the cost of living.

Reform the DDRB

Currently, doctor’s pay is reviewed annually by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), who make recommendations to the government. The BMA wants to introduce an independent review body, claiming in a report that the government has repeatedly interfered with the pay review process.

How much do junior doctors currently get paid?

In 2016, following a three-day strike by junior doctors, a new contract was agreed that guaranteed junior doctors a 2% pay increase in the year 2022/23. This meant that junior doctors were not included in the annual review by the DDRB.

Under the 2016 contract, junior doctors’ basic pay ranges from £29,384 to £58,398, depending on their seniority.

In comparison, junior doctors in Australia earn an average of AU$ 70,000 (around £36,000) and the average junior doctor’s salary in Canada is $110,361 (around £65,000).

What is the government’s response so far?

The government is currently refusing further negotiations for as long as the strike action continues.

A spokesman for Prime Minister Rishi Sunak said on Tuesday:

“We have sought to come to a fair resolution - fair for the taxpayer, fair for hardworking doctors and health workers.”

He added that deals with other healthcare workers’ unions showed the striking junior doctors were “outliers” and continued:   

“We have achieved that in the majority of cases ... we are willing to have further discussions. But obviously the first thing to do is to stop striking.”

Health Secretary Victoria Atkins said she wanted to find a “fair and reasonable solution to end the strikes once and for all”, but reiterated that junior doctors need to call off their strike before talks could continue.  

Why are junior doctors asking for such a high pay increase?

The 35% pay rise requested by junior doctors has been criticised by many as unfair and unachievable.

The BMA’s claim that junior doctor’s pay has fallen by 26% in real terms since 2008/09 was based on measuring inflation using the Retail Prices Index (RPI). However, both the Institute for Fiscal Studies (IFS) and the Office for National Statistics (ONS) say that the RPI is notoriously flawed as a measure of inflation. Both agencies put the actual figure at a decrease of between 11% and 16% since 2010.

Other public sector workers, including nurses (10.2%), health visitors (13%), teachers (13%) and senior police officers (17%) have seen similar pay reductions in real terms since 2010.

What are the implications of the junior doctor’s strike for the NHS?

The junior doctor’s strike means that senior doctors are being drafted in to cover emergency care, stretching staff further across an already overstretched system. This means that routine hospital services such as planned operations and check-ups are being heavily disrupted.

The knock-on effect of the junior doctors strike is already being felt across the NHS with several hospitals such as the Queen Alexandra in Portsmouth stating that its A&E department was “full”. and declaring a critical incident — meaning they may not be able to provide critical services for patients.

In Nottinghamshire, the entire Nottingham and Nottinghamshire NHS system declared a critical incident. Cheltenham A&E has been closed with patients diverted elsewhere.

Since December 2022, over a million patient appointments have been cancelled due to strikes at an estimated cost of £1 billion.

Is there a solution to the strike action?

As the pay dispute continues, it’s left to the already beleaguered NHS and its overstretched staff to pick up the slack, and services to the most vulnerable — the patients, are once again thrown into disarray.

Junior doctor’s grievances are real. Without proper pay and conditions, doctors will continue to leave the profession, and the ones that remain face overwork, poor job satisfaction and burnout.

However, negotiation is the only way forward. Though uncomfortable bedfellows, the government and junior doctors need each other. The sooner a realistic agreement can be made, the sooner doctors can get back to doing what they love — treating patients.