Why the NHS doctors’ strikes look set to continue

As resident doctors began a new round of industrial action on Friday, it felt very like the other 49 days of strikes since March 2023, with medics in scrubs on picket lines outside hospitals across England amid a battle for public sympathy. The British Medical Association claimed the stoppage was wholly justified while the health secretary, Wes Streeting, riposted that it was irresponsible and risky. Meanwhile, many thousands of patients had their appointments or surgery cancelled as hospitals attempted to minimise the disruption. They were collateral damage, as usual. Related: This week’s doctors’ strike is another test of Wes Streeting’s mettle. He is right not to buckle | Polly Toynbee It is now one of the longest-running disputes in NHS history. The UK is on its fourth prime minister since the BMA decided at its annual conference in June 2022 that resident – at the time still called junior – doctors in England deserved “full pay restoration”. Boris Johnson fell a month later. Since then, Liz Truss, Rishi Sunak and now Keir Starmer have grappled with the union’s demand, which seeks to return resident doctors’ pay to the level it was at in 2008, before austerity-era low annual rises and inflation eroded the real-terms value of their salaries. There are 70,000 such medics, who range from the newly qualified to those about to become consultants, of whom 60,000 are in the BMA. The union initially sought a 35% hike to resident doctors’ salaries. Before this latest stoppage they had struck 12 times, 11 of them under the Conservatives. That has led to about 1.5m outpatient appointments and surgeries being rescheduled. Their campaign has borne fruit. Pay has risen 28.9% over the past three years, including by 22% under Labour. But stubbornly high inflation means that a further 26% uplift is still needed to achieve full pay restoration, the union says. This 13th strike will continue until 7am next Wednesday. Talking to BMA insiders, it emerged that the roots of the dispute owe almost as much to the internal politics of the doctors’ union as to the fact that government policy has made medics poorer over time. They paint a picture of how many of its members, especially younger, early-career doctors, felt let down by the union over a series of events, starting with the failure of junior doctors’ bitter dispute in 2015/16 with the then health secretary, Jeremy Hunt, over weekend working. That, together with the pandemic and arguments over pay, bred a lot of “disillusionment, frustration and anger” with the BMA among doctors, one senior figure explained. “By 2021 and 2022, many regular doctors felt that the BMA was very out of touch with their concerns, especially junior doctors, who felt that it no longer represented them effectively. “Year after year, doctors were receiving below-inflation pay awards and the BMA were seemingly doing nothing about it. The clapping on Thursdays during the pandemic never materialised into any meaningful recognition at the pay packet. There was a sense of betrayal by the government and disappointment in the BMA.” A second well-placed insider agreed. “Juniors, who were not well paid, felt that the BMA had fallen by the wayside on pay. They’d also had their messes taken away, couldn’t get food in their hospitals overnight, and were sent around the country at short notice, which was a cause of great distress,” they said. The union’s 2022 conference in Brighton took place amid this unhappiness. A previously unheard of group, Doctors Vote, staged what insiders call a coup by getting its supporters elected to almost half the seats on the BMA’s 69-member ruling council. It had only one aim in full pay restoration and was determined to achieve it. And it succeeded in ensuring that the union backed unending strikes as the means. Discontent with the BMA’s perceived failings helped rally doctors behind them and force the BMA to go along with the push for full pay restoration. Doctors Vote, which also gained control of the BMA’s resident doctors committee (RDC), used its influence to push the BMA into what, given its history, was a militant new approach to pay negotiations. Emma Runswick, a key protagonist in the coup, became the BMA’s deputy chair of council – deputy leader – and in that role became dominant in deciding its tactics and public positioning over what from March 2023 became regular strikes. One veteran of the 2022 “coup” said: “The BMA management had been dragging their feet about it [full pay restoration] for years and ignoring policy from BMA members. BMA management were very clear that they thought the pay restoration demand was ridiculous.” The BMA says it “strongly refutes” that. But the same insider said a rift opened up between the Doctors Vote grouping and the union’s management, whom they saw as an obstructive “old guard” of timid “bureaucrats”. The determined doctors won the power battle and as a result the BMA – which is a professional association as well as a trade union – is much more hardline in its demands and strategy. Doctors Vote imploded earlier this year amid what one insider called “horrendous infighting”. Unlike his recent predecessors, Dr Jack Fletcher, who became the RDC chair in September, is not part of that faction. However, he is just as determined to get full pay restoration. The BMA council has already approved his request for the RDC to reballot its members in January, when its current legal strike mandate expires. That could lead to another six months of strikes into mid-2026. The resident doctors committee has also made its dispute with the government two-pronged by adding the chronic lack of medical speciality training places available to doctors as an issue. Streeting has made two offers to expand such places but the RDC has rejected both as too little given the number of unemployed doctors. What began as a row over pay now involves jobs too, and so will be even harder to solve. One senior figure said: “Given resident doctors have had a 29% pay rise in recent years, and thus far seen only limited public support for them wanting another 26%, the RDC taking up a cause that the public will understand – doctors being out of work at a time when they often can’t get an operation or GP appointment – is smart and could strengthen their hand in dealing with Streeting.” Streeting hopes the RDC will fail to get the 50% turnout it needs to continue its campaign in its next ballot. But BMA sources believe it will and foresee no end to the strikes. If anything, the RDC is likely to use monthly strikes of up to a week at a time to apply pressure on the minister, who is adamant he has no money to improve on the 5.4% rise he imposed on residents this year. There is no optimism that the dispute will end any time soon. The BMA and Streeting remain miles apart and both are hemmed in – by full pay restoration being an article of faith inside the union and the government’s lack of money. Crucially, the BMA’s public demands – for Streeting to agree to deliver full pay restoration, albeit via a multi-year pay deal, and act boldly on training places – reflect the union’s core aims and are not just opening strategies in a negotiation. Despite having lost public sympathy and the chaos and lost income their strikes cause, the BMA remains determined to pursue its goals whatever the cost. It sees its demands as reasonable given the vital role doctors play. Streeting has had only two strikes to contend with so far on his watch but, given the union’s stance, he may find them becoming an unwelcome new normal in 2026.