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\n 11 min read21 February
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The long-running resident doctors\u2019 dispute that has dogged successive governments may finally be nearing resolution. But, as Noah Vickers reports, there are formidable hurdles ahead before Wes Streeting can declare \u2018mission accomplished\u2019<\/p>\n
Wes Streeting, less than a month into his new job as Health Secretary, declared that a strike that had \u201ccaused untold misery to patients and staff\u201d was all but over.<\/p>\n
He had, after all, just handed a 22.3 per cent pay rise to resident (formerly known as junior) doctors after 11 rounds of industrial action, in the weeks after Labour\u2019s election victory in July 2024. Settling the strikes had been his \u201cpriority from day one\u201d, he said, jubilant that the British Medical Association (BMA) had accepted the award.<\/p>\n
Except that \u2013 as we now know \u2013 the huge settlement did not end the strikes. Within 11 months, the BMA was back on the picket line to Streeting\u2019s extreme displeasure. To his critics, a hubristic Streeting has been taught a painful and expensive lesson in power dynamics. His allies insist that his approach is slowly working.<\/p>\n
There are indeed signs that \u2013 despite winning a fresh mandate for yet more strikes \u2013 a new leadership at the BMA is looking for a way out. But the finishing line is still some way off and the obstacles forbidding. A deal to reduce competition for specialist posts from foreign graduates could cause problems elsewhere. And other health staff with pay claims of their own are watching like hawks.<\/p>\n
First, tempers need to cool a little \u2013 on both sides \u2013 for any settlement. \u201cWe gave them a big pay increase because we recognised their value, and I think there was a feeling that we\u2019d get them on our side. That clearly hasn\u2019t happened,\u201d says one Labour MP.<\/p>\n
The BMA argues that resident doctors\u2019 pay remains 20.8 per cent lower in real terms than it was in 2008, which they say is when their pay cuts began. Critics point out that they use the RPI rather than CPI measure of inflation to reach that percentage, and that most resident doctors had not even started their medical degrees in 2008.<\/p>\n
The most recent round of strikes, held just before Christmas, saw tempers run high. Streeting accused resident doctors of taking a \u201cself-indulgent, irresponsible and dangerous\u201d decision by choosing to strike during a flu season, \u201cat a risk of serious harm to patients\u201d. Dr Jack Fletcher, chair of the BMA\u2019s resident doctors committee (RDC), said politicians were \u201cscaremongering\u201d by suggesting that the number of flu cases was more severe than in reality.<\/p>\n
Since the new year, however, the tone on both sides has become more conciliatory. Earlier this month, the BMA\u2019s resident doctor membership voted by 93 per cent in favour of extending their mandate for strike action for another six months \u2013 but crucially, this was on a reduced turnout of only 53 per cent, suggesting that enthusiasm for the cause has ebbed somewhat.<\/p>\n
\u201cI don\u2019t think the doctors have an appetite for years of rolling strikes, like they\u2019ve had for the last three years,\u201d says one Labour MP. \u201cIf you mandated all the doctors to vote, my guess is that the actual appetite for striking among all the doctors is not there. This is not the miners\u2019 strike. The sort of people that get involved in BMA politics are a self-selecting group.\u201d<\/p>\n
For its part, the BMA claims it does not plan to use its new mandate.<\/p>\n
\u00a0\u201cThere is no intention to go on strike,\u201d RDC deputy chair Dr Arjan Singh told the BBC\u2019s Today programme. \u201c[It is] a negotiating tool, but we\u2019ve got no intention of actually using it. I would say that our relationship with government over the last few months has become increasingly positive.\u201d<\/p>\n
The BMA declined to make Fletcher, Singh or any of their RDC colleagues available for an interview with The House. MPs who have met Fletcher, however, say he is a \u201cserious\u201d and \u201cco-operative\u201d figure who \u201cwants to see a solution\u201d. They also point out he is a Labour member who \u201cwants the government to work\u201d.<\/p>\n
One MP adds: \u201cHe has a committee who I think are not always on the same page as him, because they\u2019re a little bit more militant.\u201d<\/p>\n
Before Fletcher was elected last year, the committee\u2019s four previous co-chairs belonged to a hardline faction called DoctorsVote. It was this group which had pushed hardest for strike action and for \u201cfull pay restoration\u201d to 2008 levels. DoctorsVote no longer holds any officer positions on the RDC committee, but full pay restoration \u201cby 2027\/28\u201d remains BMA policy. Fletcher is said to regard this aim as \u201cnot realistic\u201d.<\/p>\n
The BMA says the dispute is not only about pay but also about addressing the \u201cbottleneck\u201d that resident doctors face when applying for specialty training posts. The \u2018competition ratio\u2019 for those jobs has got tighter over recent years, largely due to an increase in applications from international medical graduates (IMGs) \u2013 which leaves many UK-trained doctors unable to progress in their careers.<\/p>\n
To address that issue, the government is passing emergency legislation \u2013 the Medical Training (Prioritisation) Bill \u2013 which will ensure UK-trained graduates are prioritised for foundation and speciality training posts. Streeting claims that for speciality posts, the bill \u201ceffectively reduces the competition for places from 4-1 to 2-1\u201d.<\/p>\n
The legislation was given its First Reading on 13 January, and the government aims for it to receive Royal Assent by 5 March. Passing the bill by that deadline should mean its effects are felt by this year\u2019s round of applicants, whose jobs would start in August.<\/p>\n
Yet there are concerns that the rushed-through bill could have damaging impacts on the government\u2019s ambitions elsewhere in the health service.<\/p>\n
Lucina Rolewicz, a fellow at the Nuffield Trust, warns that the NHS has \u201cpreviously relied\u201d on IMGs \u201cto fill a big proportion of general practice training places, so if this bill deters them from applying for jobs that are less popular with UK graduates, it could torpedo efforts to expand general practice, especially in poorer areas\u201d.<\/p>\n
She tells The House: \u201cCompetition and interest in different specialities are not equal. This is especially the case in general practice and for core psychiatry training as well\u2026<\/p>\n
\u201cThe bill won\u2019t stop internationally trained doctors from applying to those routes, but it could discourage them from putting applications forward in the first place.\u201d<\/p>\n
![\"Wes](\"https:\/\/www.newsbeep.com\/uk\/wp-content\/uploads\/2026\/02\/3DHBCD3.jpg\")
\nHealth Secretary Wes Streeting (Alamy)
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Stuart Hoddinott, associate director at the Institute for Government, points out: \u201cAlmost the entire increase in the GP trainee workforce, since 2019, has come through IMGs\u2026 They now make up more than 50 per cent of GP trainees. This is a very important route for general practice.\u201d<\/p>\n
More deprived areas, including many of the rural and coastal areas now turning to Reform UK, could be especially badly hit by any downturn in international applications, as UK-trained doctors disproportionately tend to apply for GP posts in urban areas close to the teaching hospitals where they studied.<\/p>\n
When it comes to settling the dispute, however, there is a quiet optimism in Parliament that once the bill has been passed in March, a deal could potentially be reached with the BMA in the weeks that follow, without any further strikes having been called.<\/p>\n
\u201cThat\u2019s the intention of the Secretary of State,\u201d says a Labour MP. \u201cIn the early spring, hopefully there\u2019ll be a relatively harmonious deal, and they can move forward.\u201d<\/p>\n
But anyone watching the dispute agrees that the BMA is serious about needing to also see some form of improved pay offer \u2013 and one may be on the way.<\/p>\n
\u201cIt sounds like there will be a pay-off of some sort which might be attractive,\u201d says an MP, who adds: \u201cWhat\u2019s needed is a multi-year settlement which is just a little bit over inflation \u2013 that would solve the [pay] problem.<\/p>\n
\u201cI would give them a three-year rolling pay settlement, and I\u2019d give it at a percentage or two above inflation for two years, and then a bit more in the third year. You\u2019re not going to take it back to some mythical date of 2008, because it\u2019s not affordable.\u201d<\/p>\n
But even a deal of that nature would risk further problems for Streeting, as other unions representing healthcare workers would take immediate notice of it.<\/p>\n
\u201cI don\u2019t envy Wes Streeting in his job at the moment, because he\u2019s got to balance all these things out,\u201d says one backbencher. \u201cHe wants the doctors back. That might involve a more-than-inflationary pay increase, which then might bring all of the other professions into play.<\/p>\n
\u201cThe main cost for the NHS is people. If you lose control of the pay aspect, then the costs will go up enormously.\u201d<\/p>\n
Unions representing NHS staff tell The House they are monitoring the resident doctors\u2019 dispute and do not rule out balloting their own members for strike action if a generous deal is agreed.<\/p>\n
\u201cAll NHS staff are deserving of above-inflation pay rises,\u201d says Richard Munn, national officer for health at Unite, which represents almost 100,000 healthcare workers.<\/p>\n
\u201cUnlike resident doctors, the lower-paid NHS staff do not have the opportunity to progress to be consultants, GPs or surgeons as their careers develop.<\/p>\n
\u201cWe hope that the government will see the unfairness of treating doctors more favourably than other NHS staff and will look to offer all staff above-inflation pay offers.\u201d<\/p>\n
A spokesman for the Society of Radiographers says their union is watching the resident doctors\u2019 dispute \u201cwith interest\u201d, adding that \u201cballoting for strike action would depend on what follows for other NHS staff and how this is received by our members\u201d.<\/p>\n
The Royal College of Nursing, meanwhile, says it was \u201can insult\u201d for the government to offer a 3.3 per cent pay uplift to their members and has pledged to \u201clook at whether this is fair treatment compared to other professions and sectors\u201d.<\/p>\n
Hoddinott says: \u201cThe resident doctors are actually a relatively cheap staff group to pay. If you want to pay them a lot more money, you can actually do so relatively easily.<\/p>\n
\u201cAn extra percentage point increase in their salary is worth roughly \u00a351m, which sounds like a lot, but in NHS terms is not that much.<\/p>\n
\u201cMore worrying is the contagion effect to other staff groups \u2013 if you get \u2018Agenda for Change\u2019 staff, which is all non-medical staff in the NHS, walking out.<\/p>\n
\u201cIf you give them a percentage point increase that matches the resident doctors, that is suddenly something like \u00a3730m. That starts to get very expensive, very quickly.\u201d<\/p>\n
For Streeting, there will also be a personal incentive to resolving the dispute. The Health Secretary has been touted as a challenger to Keir Starmer\u2019s leadership, and preventing further strikes \u2013 by reaching a deal which the public believes to be fair \u2013 will be a key test for him.<\/p>\n
\u201cIt\u2019s damaging for any secretary of state to have this hanging over their head,\u201d says Hoddinott. \u201cIt gives the impression of dysfunction, and it does hurt your ability to demonstrate progress towards your ambitions.\u201d<\/p>\n
A DHSC spokesperson said: \u201cResident doctors have already had a 28.9 per cent pay rise over the last three years \u2013 we\u2019ve gone as far as we can on pay this year.<\/p>\n
\u201cWe\u2019re working constructively with doctors on the long-standing issues they face in their careers and we\u2019ve already made progress, including fast\u2011tracking legislation so UK medical graduates get priority for specialty training places. Our focus remains firmly on continuing this work and preventing strike action, which has already caused too much disruption for both patients and NHS staff.\u201d<\/p>\n
In a written statement, Fletcher told The House: \u201cThis is not a problem the government can wait out.<\/p>\n
\u201cFrom the very start of my engagement with government, I have made clear I am serious about getting to a deal. Strikes could have been avoided from the get-go if government had simply engaged with us on those terms.<\/p>\n
\u201cSadly, we had to go through strike action before they would talk seriously. We hope that the talks we are now in will result in an offer that means there need be no further strikes.\u201d<\/p>\n
Regarding pay erosion since 2008, he added: \u201cOur job is not 21 per cent less difficult, so it should not be paid 21 per cent less. The choice to cut this pay was a political one and the choice to restore it must be a political choice too.\u201d\u00a0<\/p>\n
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11 min read21 February
The long-running resident doctors\u2019 dispute that has dogged successive governments…\n","protected":false},"author":2,"featured_media":440680,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[43],"tags":[102,2960,56,54,55],"class_list":["post-440679","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-health","tag-healthcare","tag-uk","tag-united-kingdom","tag-unitedkingdom"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/440679","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/comments?post=440679"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/posts\/440679\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media\/440680"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/media?parent=440679"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/categories?post=440679"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/uk\/wp-json\/wp\/v2\/tags?post=440679"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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