Mix of relief and disappointment—striking a balance in the pay deal for resident doctors in England
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj.q2116 (Published 27 September 2024) Cite this as: BMJ 2024;386:q2116
On 16 September 2024, the BMA announced that its members had voted to accept the pay deal offered by the government for resident (previously known as “junior”) doctors. As a newly qualified doctor who started working less than two months ago, I have had much of my studying and training affected by industrial action and the covid-19 pandemic. Despite being among the cohort of doctors who have not taken part in any official strikes, as none were scheduled during our first months working, my time on clinical placements was continuously coloured by the pay dispute and declining morale.
The pay offer was announced during my induction week—a mixed wave of relief and disappointment ran through the lecture theatre as we all collected our first “Dr” ID badges and met our new colleagues. It was immediately clear that the proposed deal was divisive. Two years ago, resident doctors were balloted for a mandate to strike, with a 77% voter turnout and 98% voting yes.1 The issue of pay was widely understood to be harming workforce retention and hampering doctors’ ability to work safely and sustainably in the NHS—a problem severe enough to warrant industrial action. However, when the recent deal was put to members, there was a turnout of 69%, of whom two thirds (30 227) voted in favour of the offer and one third (15 596) against.2 The contrast between these statistics alone highlights the uncertainty among resident doctors about the pay deal.
It seems to me that one thing resident doctors unanimously agree on is how the mainstream media has presented the pay deal—with misleading headlines and an unfair summation of figures. The quoted “22% pay rise” is an oversimplification of the deal, which can be broken down into previously agreed increases (about 9%), further cumulative rises (about 4%), back payments (6%), and a lump sum of £1000.3 The majority of the pay deal would have been awarded regardless of the outcome of the BMA vote. Doctors are being painted as “greedy” and “asking for too much,” when in reality the outcome of the deal is equivalent to what our 2020 (pre-covid) pay should have been if we’d had salary increases that matched inflation.4
No choice but to strike
I have never met a doctor who wanted to strike. We all want the best for our patients, so it’s been disappointing when the media painted the assumed impact of strike action on the public through a moralising lens, focusing on the risks to patient care, long waiting lists, and other disruptions strikes cause, as if doctors don’t feel these problems as keenly as anyone. This depiction also ignores evidence that suggests key patient outcomes are “unaffected by junior doctor strike action.”5 Every doctor I have spoken to believed that they were left with no choice but to strike, pushed to industrial action as a last resort to save the NHS. Doctors who went on strike made huge personal sacrifices, suffering pay cuts and increased workloads around strike days. Some doctors even faced risks to their career progression because of strict guidelines on time out of training, and others told me that going on strike directly harmed their relationships with senior colleagues.
It’s no wonder then that many doctors say they are tired of industrial action, and perhaps this strike fatigue is another factor for the majority decision to accept the last pay offer. The campaign’s momentum has started to falter, highlighted by reductions in the numbers of doctors turning out for strikes and ballots,126 and many doctors are willing to take the offer with some cautious optimism. Pay was only one of the myriad problems doctors in the UK face every day—from compulsory fees for professional registration or exams and growing student loan debts, to poor working conditions, and fears about career progression because of increasing training application bottlenecks and declining employment opportunities (highlighted by the controversial ongoing discussions about defining roles for allied health professionals, such as physician associates).7
A pay deal may allay some of these concerns, especially as the deal is multifactorial and includes some non-pay terms, but many doctors are angry about the outcome of the vote. Online debates are as mixed as the conversations I have had in person with friends and colleagues across varying stages of training.8 Commentators online have pointed out how under the new deal, the foundation year 2 doctor base salary is less than the starting salary of a physician associate. Although some question the relevance of these direct comparisons with other roles, many doctors feel it is unfair to be paid less, despite having more training and clinical responsibility. Other issues include tax on back payments, which will see doctors who have progressed in their training take home less from this award than if they had been paid it last year, because of earning more in their new roles.
Looking ahead
There is a general air of confusion among resident doctors, with many openly admitting that they do not fully understand the pay deal or what it means for them financially and for future potential industrial action. For doctors who, like me, began working in August 2024, elements such as the lump sum (jokingly referred to as the Monopoly £200 when you pass go) are welcome help after finishing university and relocating before getting our first pay cheques. Some feel encouraged to have reached any sort of credible offer so quickly from the new government and see it as a step in the right direction. On the other hand, many doctors feel let down, particularly by the government’s lack of commitment to full pay restoration, as seen in the Scottish deal.
The campaign, however, is not over, as BMA representatives have said that “there is still a way to go,”9 framing the result as the start of a “journey” to ensuring the workforce is not underpaid or undervalued again. There is still risk of further industrial action in the future, depending on outcomes of the independent pay review body and the government’s response. But for now, resident doctors in the UK can return to their jobs uninterrupted by strikes, focusing on providing the best possible patient care.
Footnotes
Competing interests: Nikki is a current foundation doctor working in the NHS, who is directly affected by this pay deal. Nikki was the BMJ editorial scholar 2020-21.
Provenance and peer review: Commissioned; not externally peer reviewed.