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Junior doctor strikes are unsustainable – a fair pay compromise is needed


4 min read

Over Easter, I spent four nights working in a busy London hospital providing senior medical cover during the latest round of industrial action by junior doctors.

Even after four busy shifts, the view of the Palace of Westminster from across the river is truly beautiful in the early dawn light, and in general, I enjoyed the experience. Clinical colleagues came together well under pressure, and it was good to once again to work alongside friends that I have not seen since medical school.

During the strike, from a patient perspective, if you were seriously unwell and attended accident and emergency, there were senior and experienced clinical decision makers ensuring that you received only the very best care. However, whilst the emergency department was well run, it was rather a different story if you were booked for an elective hip operation or an outpatient appointment, because the likelihood is that your operation or appointment would have been cancelled.

More could be done across the NHS workforce to phase in a meaningful increase in pay – perhaps over five years

One of the government’s top priorities is to cut waiting lists and to get on top of the backlog of care created by the covid pandemic. I wish the government luck with that ambition unless industrial action by NHS staff comes to an end very soon.

Industrial action on this scale is unprecedented in the history of the NHS and is hugely disruptive to patient care. At least both the government and the health unions recognise that the current situation is unsustainable. But with the Royal College of Nursing announcing another walk out, and ominously, the BMA indicative ballot of the consultant workforce indicating support for strike action, the situation appears to be escalating rather than moving towards a resolution.

NHS staff feel torn between their commitment to patients and a recognition that their pay has been eroded in real terms since austerity and NHS pay restraint began under Gordon Brown in 2007/8. This is particularly true for nurses and doctors where real terms erosion of pay is over 15 per cent, as measured against CPI and more if measured against RPI inflation. In contrast, workers in the private sector have seen a modest increase in their pay during the same period.

Real terms erosion of staff pay together with the recent rising cost of living has compounded the exhaustion felt amongst much of the NHS workforce following the intensity of the Covid pandemic, and the result is a workforce that feels undervalued and demoralised. Many staff are voting with their feet, and leaving permanent jobs to instead go to work for more money at private health providers or for healthcare locum and temporary staffing agencies. Others, particularly junior doctors are taking their skills abroad or leaving the profession altogether.

From the government’s perspective this is bad healthcare economics, as locum and agency staff are very expensive, and the cost of redeploying staff during the current industrial action is having a significant impact upon the finances of most hospital trusts. It would be far better to better remunerate existing staff and to retain them in the workforce than to pay more and more money to expensive locum and temporary staffing agencies. It would also end the ever-growing resentment amongst permanent NHS staff that agency staff are being paid twice as much as they are for doing the same job.

After my final night shift, I sat down for breakfast with a number of senior medical colleagues, some with a national profile. I had personal reflections about how, in general, acute trusts are much better financially and organisationally managed than mental health trusts. I hope that one day a government addresses this challenge. But, all of those sat around the table recognised the unsustainability of the current situation, and there was concern at the intransigence of both sides in the dispute.

Whilst the government is right that a 25 per cent or 35 per cent one off rise in NHS pay is not realistic, more could be done across all of the NHS workforce to phase in a meaningful increase in pay over a period of time – perhaps over five years. For junior doctors, who are often £80,000 in debt after medical school, something could also be done to write off the debt perhaps in return for 10 years of NHS service post qualification.

This dispute needs to end and to end quickly. Both sides need to start talking to each other, and to agree a solution, because until they do, the real losers will be our patients.


Dr Dan Poulter, Conservative MP for Central Suffolk & North Ipswich, NHS junior doctor and former health minister. 

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