‘No Wonder Junior Doctors have Voted to Take Industrial Action’
Consultant David Oliver explains how the pressures and demands on his younger colleagues have led to an overwhelming vote to strike this spring
Yesterday, the BMA Junior Doctors’ voted overwhelmingly in favour of industrial action. With a voter turnout of 77.5%, 98% supported a strike, planned to be a 72-hour withdrawal of labour in mid-March unless the government comes to the table and negotiates meaningfully on pay.
This is not a workforce group given to striking. There was action in 1975 and 2016 over contracts, but in both cases, it was far more limited in scope than the BMA is proposing this time.
If it goes ahead, this strike will certainly be noticed and the work of the junior doctors will be sorely missed. Although they are in training grade posts, in reality, the service delivery of inpatient NHS medical care is heavily reliant on their presence on site 365 days a year, 24 hours a day. There are not enough consultants to do the work without them, even if there will be short-term workarounds and staff substitutions to keep services running during those three days.
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The term “junior doctor” is problematic because in many cases there is nothing “junior” about them. Acceptance rates to UK medical schools vary from 26% to 7% for a five or six-year course (though there are now 4-year options for some post-graduates). Required entry grades are high and the demands of the course are intense and rigorous.
Following qualification – in the mid-20s for even the youngest medical graduates – years of postgraduate training, study and serial, exacting examinations remain. Even for a doctor who trains full-time and goes straight through with no breaks from the programme, it takes between six to nine years to become a GP or Consultant and longer for those who pursue research and academic qualifications.
Since the introduction of course fees, UK medical students now graduate saddled with a median £100k debt. Yet the National Health Service is both a monopoly employer and a monopoly postgraduate trainer. Not only are recruiting people to work in key public sector roles providing a public service but also charging them for the privilege.
On top of this, they have to pay through the nose for professional examinations and portfolios of evidence to support their progression. The rotational nature of training means that most junior doctors will move hospital or town repeatedly during their training, or face lengthy commutes around a big training region. This is even more burdensome if in a two doctor couple.
The previous perks – free if basic on-site on-call accommodation, parking or access to subsidised hot food, rest areas or even advance notification of rotas or flexibility with leave booking – have all gone. In specialities or hospitals with staffing and rota gaps, there is endless pressure to cross-cover vacant slots and workload or patient numbers that can become unmanageable, unsafe or unsustainable. The balance between properly supervised training opportunities and service provision often suffers.
Three years of COVID medicine has taken a major toll on many staff, with burnout a growing issue, and NHS clinical staff were far more likely than other groups of workers to contract COVID (and hence Long Covid themselves)
For all NHS workforce groups the service can be a grim and relentless environment right now. We have serious overcrowding, long waits and worsening response times and major exit block in acute care, over 7 million people on waiting lists for elective care and a massive post-COVID catch-up operation and a broken social care system which impacts the NHS and we have faced a huge number of unfilled vacancies across all parts of the system.
On pay, the BMA Junior Doctors have asked for “full pay restoration” for the real terms salary deflation they have lost since 2008 – of 26% in line with inflation.
In 2022, the Nuffield Trust compared NHS staff pay to inflation and to the private sector since 2010 and demonstrated a significant erosion in terms for doctors of all grades, alongside other NHS staff groups.
So far, the government (in England) response has been to refuse to negotiate with doctors or any other clinical staff group about pay within this financial year, despite repeated claims by ministers that “the door is open”; to point out that junior doctors (whose salaries fall outside national pay review body remits) already have a multi-year deal and to hint that they may be open to negotiation about settlements for future financial years.
Ministers also continue to claim that public sector wages will drive inflation and so harm all groups of workers, even though inflation and interest rates have already soared on the back of Brexit, food and energy costs and the Ukraine conflict, with no public sector pay rises in sight.
They clearly plan to tough things out despite continuing high levels of public support for NHS staff and hope that the public and press turn on the medics.
Whilst I don’t think doctors’ nurses and ambulance unions expect to see the kind of pay restoration that is their starting negotiation point, I think not settling is a high-stakes game for the government.
Highly trained medical graduates have qualifications and skills which are in short supply globally and are both better rewarded in some other nations and transferrable to other sectors. Junior doctors are already leaving their postgraduate training programmes, the NHS or the UK and many more, when surveyed, are signalling their intent to do so.
When it takes years of undergraduate and postgraduate training to produce replacements for those doctors who depart, the government will learn the hard way that you cannot recruit your way out of a retention crisis.
Their refusal even to negotiate is an act of self-sabotage. And I guarantee that even over three days of industrial action, we will be left in no doubt of the vital contribution so-called “junior” doctors make to our NHS.
David Oliver has been an NHS consultant for 25 year and spent 9 years as a rotational junior doctor before that. He is a BMJ Columnist, a former Vice President of the Royal College of Physicians and ex-President of the British Geriatrics Society and a previous Department of Health National Clinical Director
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