The House | An End To The Resident Doctors’ Dispute Could Cause New Problems For Government

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Wes Streeting, less than a month into his new job as Health Secretary, declared that a strike that had “caused untold misery to patients and staff” was all but over.

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’s election victory in July 2024. Settling the strikes had been his “priority from day one”, he said, jubilant that the British Medical Association (BMA) had accepted the award.

Except that – as we now know – the huge settlement did not end the strikes. Within 11 months, the BMA was back on the picket line to Streeting’s 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.

There are indeed signs that – despite winning a fresh mandate for yet more strikes – 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.

First, tempers need to cool a little – on both sides – for any settlement. “We gave them a big pay increase because we recognised their value, and I think there was a feeling that we’d get them on our side. That clearly hasn’t happened,” says one Labour MP.

The BMA argues that resident doctors’ 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.

The most recent round of strikes, held just before Christmas, saw tempers run high. Streeting accused resident doctors of taking a “self-indulgent, irresponsible and dangerous” decision by choosing to strike during a flu season, “at a risk of serious harm to patients”. Dr Jack Fletcher, chair of the BMA’s resident doctors committee (RDC), said politicians were “scaremongering” by suggesting that the number of flu cases was more severe than in reality.

Since the new year, however, the tone on both sides has become more conciliatory. Earlier this month, the BMA’s resident doctor membership voted by 93 per cent in favour of extending their mandate for strike action for another six months – but crucially, this was on a reduced turnout of only 53 per cent, suggesting that enthusiasm for the cause has ebbed somewhat.

“I don’t think the doctors have an appetite for years of rolling strikes, like they’ve had for the last three years,” says one Labour MP. “If 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’ strike. The sort of people that get involved in BMA politics are a self-selecting group.”

For its part, the BMA claims it does not plan to use its new mandate.

 “There is no intention to go on strike,” RDC deputy chair Dr Arjan Singh told the BBC’s Today programme. “[It is] a negotiating tool, but we’ve got no intention of actually using it. I would say that our relationship with government over the last few months has become increasingly positive.”

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 “serious” and “co-operative” figure who “wants to see a solution”. They also point out he is a Labour member who “wants the government to work”.

One MP adds: “He has a committee who I think are not always on the same page as him, because they’re a little bit more militant.”

Before Fletcher was elected last year, the committee’s four previous co-chairs belonged to a hardline faction called DoctorsVote. It was this group which had pushed hardest for strike action and for “full pay restoration” to 2008 levels. DoctorsVote no longer holds any officer positions on the RDC committee, but full pay restoration “by 2027/28” remains BMA policy. Fletcher is said to regard this aim as “not realistic”.

The BMA says the dispute is not only about pay but also about addressing the “bottleneck” that resident doctors face when applying for specialty training posts. The ‘competition ratio’ for those jobs has got tighter over recent years, largely due to an increase in applications from international medical graduates (IMGs) – which leaves many UK-trained doctors unable to progress in their careers.

To address that issue, the government is passing emergency legislation – the Medical Training (Prioritisation) Bill – which will ensure UK-trained graduates are prioritised for foundation and speciality training posts. Streeting claims that for speciality posts, the bill “effectively reduces the competition for places from 4-1 to 2-1”.

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’s round of applicants, whose jobs would start in August.

Yet there are concerns that the rushed-through bill could have damaging impacts on the government’s ambitions elsewhere in the health service.

Lucina Rolewicz, a fellow at the Nuffield Trust, warns that the NHS has “previously relied” on IMGs “to 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”.

She tells The House: “Competition and interest in different specialities are not equal. This is especially the case in general practice and for core psychiatry training as well…

“The bill won’t stop internationally trained doctors from applying to those routes, but it could discourage them from putting applications forward in the first place.”

Stuart Hoddinott, associate director at the Institute for Government, points out: “Almost the entire increase in the GP trainee workforce, since 2019, has come through IMGs… They now make up more than 50 per cent of GP trainees. This is a very important route for general practice.”

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.

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.

“That’s the intention of the Secretary of State,” says a Labour MP. “In the early spring, hopefully there’ll be a relatively harmonious deal, and they can move forward.”

But anyone watching the dispute agrees that the BMA is serious about needing to also see some form of improved pay offer – and one may be on the way.

“It sounds like there will be a pay-off of some sort which might be attractive,” says an MP, who adds: “What’s needed is a multi-year settlement which is just a little bit over inflation – that would solve the [pay] problem.

“I would give them a three-year rolling pay settlement, and I’d give it at a percentage or two above inflation for two years, and then a bit more in the third year. You’re not going to take it back to some mythical date of 2008, because it’s not affordable.”

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.

“I don’t envy Wes Streeting in his job at the moment, because he’s got to balance all these things out,” says one backbencher. “He wants the doctors back. That might involve a more-than-inflationary pay increase, which then might bring all of the other professions into play.

“The main cost for the NHS is people. If you lose control of the pay aspect, then the costs will go up enormously.”

Unions representing NHS staff tell The House they are monitoring the resident doctors’ dispute and do not rule out balloting their own members for strike action if a generous deal is agreed.

“All NHS staff are deserving of above-inflation pay rises,” says Richard Munn, national officer for health at Unite, which represents almost 100,000 healthcare workers.

“Unlike resident doctors, the lower-paid NHS staff do not have the opportunity to progress to be consultants, GPs or surgeons as their careers develop.

“We 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.”

A spokesman for the Society of Radiographers says their union is watching the resident doctors’ dispute “with interest”, adding that “balloting for strike action would depend on what follows for other NHS staff and how this is received by our members”.

The Royal College of Nursing, meanwhile, says it was “an insult” for the government to offer a 3.3 per cent pay uplift to their members and has pledged to “look at whether this is fair treatment compared to other professions and sectors”.

Hoddinott says: “The 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.

“An extra percentage point increase in their salary is worth roughly £51m, which sounds like a lot, but in NHS terms is not that much.

“More worrying is the contagion effect to other staff groups – if you get ‘Agenda for Change’ staff, which is all non-medical staff in the NHS, walking out.

“If you give them a percentage point increase that matches the resident doctors, that is suddenly something like £730m. That starts to get very expensive, very quickly.”

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’s leadership, and preventing further strikes – by reaching a deal which the public believes to be fair – will be a key test for him.

“It’s damaging for any secretary of state to have this hanging over their head,” says Hoddinott. “It gives the impression of dysfunction, and it does hurt your ability to demonstrate progress towards your ambitions.”

A DHSC spokesperson said: “Resident doctors have already had a 28.9 per cent pay rise over the last three years – we’ve gone as far as we can on pay this year.

“We’re working constructively with doctors on the long-standing issues they face in their careers and we’ve already made progress, including fast‑tracking 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.”

In a written statement, Fletcher told The House: “This is not a problem the government can wait out.

“From 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.

“Sadly, 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.”

Regarding pay erosion since 2008, he added: “Our 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 on,e and the choice to restore it must be a political choice too.”