Partha Kar: Senior colleagues must speak up for junior doctors in the NHS strikesBMJ 2023 ; 381 doi: https://doi.org/10.1136/bmj.p808 (Published 06 April 2023) Cite this as: BMJ 2023;381:p808
- Partha Kar , consultant in diabetes and endocrinology
Follow Partha on Twitter: @parthaskar
Here we are again: another generation of doctors striking over pay, and members of the public hearing different versions of the truth depending on their preferred newspaper or media account. Whenever the question of healthcare workers going on strike comes up, many arguments become entangled. Is it acceptable for doctors to do that? And should they do it, given that patients may be harmed? This debate isn’t new, but it is used by those who want to make doctors feel guilty for negotiating over pay.
One thing is clear, however. This time, whether we agree with the tactic or not, the BMA’s Junior Doctors Committee isn’t here to play. Junior doctors have a huge amount of support among their peers. And, powered by that mandate, they are here. The committee’s handling of the media has been calm, professional, and organised, with a clear sense that “we’re not here to please anyone bar our membership.”
The former health secretary Jeremy Hunt, aided by many in the healthcare system and the media, rode out the 2015-16 dispute with junior doctors and pushed through their contract that was the source of disagreement. But he didn’t have today’s waiting list headache or post-covid fallout to deal with. Now, with a huge NHS backlog to bring down and Hunt now chancellor, he has tried to get a handle on waiting lists by helping with the pension scheme. But, as this help is mostly aimed at consultants, it’s unlikely to help avert strike action.
NHS England, through its chief strategy officer, Chris Hopson, recently said that the strikes may be responsible for the NHS’s inability to bring down waiting lists which perhaps ignoring the multitude of other factors affecting them, not to mention an increasing list even pre-pandemic. This isn’t the only problem, however, for the NHS: there are issues in workforce recruitment and retention, with huge disgruntlement among many healthcare workers while other unions have shown signs of making headway in pay disputes by holding their ground. And no amount of planning—whether it be the Fuller stocktake report 1 or the Hewitt review 2 —has a chance of success without a settled workforce.
Then there’s the timing of the strikes. It’s been fascinating to see some people express dissatisfaction that the strikes will follow the Easter bank holidays, when many senior staff are on leave. Perhaps they need to be reminded that the purpose of these strikes is to cause inconvenience to the system to put pressure on chief executives and other leaders to progress negotiations.
Much has been made of junior doctors’ demand for “a 35% pay rise.” 3 The fact is that, if you keep their pay lower than inflation for many years, this eventually accrues to a number that looks big. It’s much simpler to look at the figure of about £1bn for pay restoration across the board. Does that look big? Perhaps. But in the context of the billions of public pounds spent and lost during the pandemic it starts to look much smaller.
Those who have objected to junior doctors asking for 35% forget that this is their starting point for negotiations. Then there’s the discussion around some junior doctors being paid £14 an hour, which has been misused in the media. This figure is reflective of a junior doctor at FY1 level pay, whereas £28 an hour is more reflective of the higher points of training—still quite low, especially when factoring in the debts junior doctors carry by way of student loans.
Benefits and improvements
So, what next? Step one is for all parties to meet at the negotiating table. If it’s not being said loudly enough then we, as senior leaders in the health service, should be adding our voices to calls for the government to reach an agreement with junior doctors.
Step two is to have nuanced discussions and for the government to consider whether it could offer junior doctors other benefits or workplace improvements beyond pay. Could the government write off junior doctors’ student debt? Could study budgets be better? How about more specialty training posts? Of course, these benefits don’t negate the importance of a proper pay trajectory that matches salaries to inflation. But the point is, with services already overstretched, we can’t ignore junior doctors’ demands or the consequences of not engaging with them.
Using the media to turn the public against junior doctors is a government strategy based on desperation. It may have worked to an extent in 2016, but this time it’s different. Public satisfaction with the NHS has dropped to its lowest level since records began. 4 And the public knows that the failings in the NHS aren’t the fault of this generation of doctors who face burnout, understaffing, stagnant pay, unsustainable debt, and a lack of career progression or opportunities to specialise.
Competing interests: see www.bmj.com/about-bmj/freelance-contributors . Partha Kar is national specialty adviser, diabetes, and lead of the Medical Workforce Race Equality Standard.
Provenance and peer review: Commissioned; not externally peer reviewed.