12.06.2025

Full pay restoration

Will resident doctors vote for another round of pay strikes? Richard Galen looks at the complex issues involved in the upcoming membership ballot

On May 27 the British Medical Association opened a ballot for industrial action for its ‘resident doctors’ (formerly known as junior doctors) in England. This came as a result of government inaction on the promises made in the aftermath of the 2023-24 strikes, even though health minister Wes Streeting had committed the Labour government to an agreed timetable on pay announcements from the review body on pay. This initially led to the BMA’s Resident Doctors Committee voting to go back into dispute with the government in April.

Since then, the review body published its recommendations and the government’s initial pay offer was announced - an uplift of 4%, plus another £750 consolidated. As the BMA stated, this fails to make up for years of pay erosion in the public sector, which was the trigger for the previous industrial action. The offer is below the Retail Price Index of inflation over the last year (4.5%), which the BMA uses to back up its pay demand - it encompasses housing and food costs a lot more accurately than other measures. These are major considerations for its members, who are often contending with ‘rotational’ training, meaning they have little control over where in the country they are employed.

The stated aim of the previous BMA campaign on pay was ‘full pay restoration’ (FPR) - a return to the inflation-adjusted salary levels for doctors in 2008. Even with the current offer, the erosion to pay amounts to more than a fifth of their salary being lost (20.9%) over the last 17 years. Some progress was made last year, as negotiations with the new Labour government resulted in an effective pay rise of 13.2% over the 2023 salary, but only nebulous commitments were made to actually fulfilling FPR. The success of the previous campaign had the effect of emboldening the RDC and the BMA in general.

Rebranding

Another change brought about at the same time was the rebranding of doctors not yet at the level of a consultant from ‘junior’ to ‘resident’ - the former was regarded as infantilising and was often used by the right-leaning media to try to discredit the campaign and the union’s efforts. The change was welcomed by the membership as long overdue, especially given that many ‘junior’ doctors have been practising for upwards of a decade and are often performing complex procedures and surgeries.

Another area where the union has seen success is in the reforms to the ‘exception reporting’ system - the way resident doctors log whenever they are forced to work beyond their scheduled hours for patient safety reasons. This system is supposed to both identify areas of unsafe staffing levels and ensure doctors are compensated for the extra work they are putting in. However, many NHS trusts have made the process time-consuming and onerous - often buried in inaccessible IT systems - and there was an ever-present fear of repercussions from seniors.

Through negotiation with the government, the agreed reforms ensure that systems are easily accessible, simple to use and backed up by robust enforcement - including fines for employers who fail to resolve the issues. The responsibility for dealing with exception reports has also been moved away from residents’ clinical supervisors, which goes a long way to addressing fears around whistleblowing.

Resident doctors are not the only BMA members considering strike action, with both the BMA consultant committee and the Specialty and Associate Specialist Committee (formed of senior doctors outside the traditional career progression pathway) also in formal dispute with the government, though neither have yet announced a membership ballot. They too are aiming for FPR, with consultant salaries having decreased by over a quarter (26.4%) of their real-terms value since 2008.

However, the first major obstacle in the union’s plan is getting the ballot to pass ‘lawful requirements’ - the oppressive requirements brought in by the previous Tory government mean that what is required is a 50% turnout, the mandatory return of ballot papers by post, and a ‘yes’ vote from a minimum of 40% of eligible members.

An issue that may end up having a negative impact on the ballot is that of International Medical Graduates (IMGs) - doctors who gained their primary medical qualification outside the UK. A major concern for resident doctors is that of specialty training places - the most common and straightforward way to progress a doctor’s career, as they specialise in a particular area of medicine (surgery, general practice, cardiology, etc).

Post-Brexit

One of the results of Brexit was that the Resident Labour Market Test for skilled workers - essentially a government policy that meant that employers had to initially offer training places to UK and EU citizens before advertising the job worldwide - was scrapped, allowing doctors from anywhere in the world to apply on an equal footing for NHS jobs, which massively increased the number of applicants from abroad.

Although this can be seen as a positive, with a shortage of doctors being a major issue for the NHS, the corresponding increase in the number of job posts simply did not happen, due to a general lack of funding in cash-strapped NHS trusts, leading to the inevitable conclusion of hundreds of applicants for each job vacancy. This has resulted in the previously unheard-of situation, where hundreds of UK-trained doctors are likely to find themselves without a job in August, when most are expected to move forward to the next stage of training.

This has led to calls from within the membership for UK-graduate or citizen prioritisation in the current job market, with many noting that almost every other country in the world operates a similar scheme, especially given the level of government subsidy for medical training. This has been driving a wedge between the IMGs and the union, with some IMGs calling for a boycott of the ballot until their concerns are acknowledged.

Interestingly, the department of health has recently expressed interest in supporting such a scheme, with cynical posts from doctors on social media speculating that this may be a deliberate move to try to sabotage the ballot - although it may also be jumping on the anti-migrant bandwagon in an attempt to pander to right-leaning voters. Either way, the BMA will have to tread very carefully in order to win enough support for the ballot to pass (voting ends on July 7) and the threat of strikes to be added to its arsenal.