by Callum McGoldrick, researcher
Junior doctors are striking again from the 25th through to the 30th July. It marks the twelfth round of strikes since 2023 and brings the total strike days up to 49. It is their first strike action since being given an inflation-shattering 22 per cent pay rise last autumn which also included backdating pay.
This time round, the British Medical Association (BMA) trade union is demanding an eye-watering 29 per cent rise. This despite the fact that their last giant pay rise was built on dishonest statistics and charged to taxpayers who are staring down a record high tax burden fast approaching and with no economic growth to see their own pay uplifted at even close to the same level.
But what makes the BMA’s claims so dishonest? Firstly, the choice of 2008 as a baseline is highly contentious. While it serves the BMA's narrative of pay erosion, starting at a different point can significantly alter the picture. For example, Wes Streeting, the Health Secretary, recently stated that resident doctors have received an average 28.9 per cent pay award under Labour already.
Furthermore, a first-year junior doctor's starting salary is now approximately £38,800, a significant increase from around £29,380 in 2022-23. The average full-time basic pay for a resident doctor is expected to reach £54,300 in 2025-26. These figures highlight substantial recent improvements that are often overlooked in the BMA's long-term historical comparison.
To add to this, the BMA's calculations predominantly use the Retail Prices Index (RPI) for inflation. RPI is an older measure that tends to be higher than the Consumer Price Index (CPI), which is the official measure of inflation used by the government and most other bodies.
As the Nuffield Trust has pointed out, using CPI can paint a very different picture. While the BMA claims a 20-21 per cent real-terms pay cut using RPI, the Nuffield Trust's analysis, using CPI, suggests a more moderate fall of around 4.7 per cent since 2008. Some calculations even show an increase if a more recent baseline is used.
Then comes arguably the most egregious fact of all. Many of the junior doctors on strike will still be working, just at an exorbitant rate through the locum system. Locum work is where doctors can fill short-term needs for hospitals and is most commonly used when a large number of staff are on leave or sick.
Crucially, locum work pays more than regular, salaried hours. It is also being used over the strike days and, just like last time, many junior doctors will be taking up locum work on enhanced pay. The only caveat is that they cannot work during the hours they were already rota’d for in the trust they work at.
The strikes have already caused mass cancellations of elective treatments. Regular hospital work will also be slowed with consultants picking up more of the slack at a maximum cost of £313 per hour, per consultant. Many standard hospital procedures will also be greatly slowed as junior doctors usually take on much of the administrative work of consultants. Due to fewer doctors working, nursing and pharmacy departments will be stretched to the maximum to cover junior doctors striking.
It is no wonder that the strikes are opposed by a majority of the British public, then. Quite simply, junior doctors are not underpaid. Certainly not after the 22 per cent increase in their pay from last year and when their generous pensions are taken into account.
Many will be wondering though why, despite finding the money to hand out pay rises last year across the NHS and broader public sector, the NHS is still so unproductive. The reason is precisely because of the pay increases.
When politicians say, ‘investment in our NHS’, what they almost always mean is, ‘an increase in day-to-day spending’. This does not equate well to healthcare outcomes. As we found in a research paper earlier this year, the UK has a relatively high spend on healthcare relative to GDP and with comparable countries. It also has an incredibly poor return on this though, finishing second last when looking at healthcare resources.
The NHS needs more capital investment, not a larger overall budget. This means more new hospitals and renovations to old ones, more diagnostic centres, new medical equipment and newer IT systems for both staff and patients. This and this alone will drive the much needed increase in NHS productivity. It is therefore critical that the government stands up to the BMA and uses the NHS budget in the right places.