LONDON – Thousands of resident doctors across England walked out on Friday morning, marking the 13th wave of industrial action since March 2023 in a bitter dispute with the government over pay erosion and chronic shortages of training posts. The British Medical Association (BMA), representing the medics formerly known as junior doctors, has called for a full walkout from 7am on November 14 until 7am on November 19, disrupting routine and emergency care at hospitals nationwide. NHS leaders have issued stark warnings of reduced frontline staffing, with up to 95% of elective procedures at risk of postponement, exacerbating already record-high waiting lists and straining resources as winter respiratory illnesses surge.
The strike, affecting nearly half of the NHS's hospital doctor workforce—around 77,000 resident doctors—comes after a dramatic breakdown in negotiations with Health Secretary Wes Streeting. The BMA's resident doctors' committee (RDC) chair, Dr. Jack Fletcher, accused the government of offering only "vague promises" for future job reforms, ignoring the immediate crisis where half of second-year foundation doctors are reportedly unemployed or underemployed due to insufficient training spots. "This is not where we wanted to be," Fletcher stated, emphasizing that the action targets both pay restoration and a "credible plan" to address the bottleneck in specialty training, which has left over 30,000 applicants competing for just 10,000 posts in recent years.
At the heart of the conflict is a demand for a 29% pay uplift to reverse real-terms losses since 2008, when inflation outpaced salary growth by an estimated 26-29%, depending on the index used. The BMA argues that successive below-inflation awards have devalued doctors' earnings, with starting salaries—now at £36,616 basic after recent uplifts—equating to as little as £14 per hour when factoring in unsociable hours and overtime. More senior specialty registrars earn up to £80,500 on average, but the union contends this still falls short of 2008 levels adjusted for inflation, contributing to burnout and an exodus of talent abroad.
The government's response has been firm. Streeting's latest offer on November 5—rejected outright by the BMA—included reimbursements for exam fees and professional memberships backdated to April 2025, alongside promises of expanded training places starting in 2027, but no further pay rise for 2025-26 beyond the 5.4% already awarded. Citing fiscal constraints under Chancellor Rachel Reeves' impending budget, ministers described the BMA's demands as "unreasonable and unnecessary," pointing to a cumulative 28.9% increase since 2023, the highest among public sector workers. A Department of Health spokesperson reiterated that the strikes lack broad public support and risk undoing progress, such as the 206,000 reduction in waiting lists since Labour took office.
This escalation follows a fragile truce. In September 2024, 66% of BMA members voted to accept a 22.3% two-year deal—comprising 13.2% backdated to 2023 and 8% for 2024-25—ending 44 days of strikes under the prior Conservative administration. That agreement, hailed as a "reset" by Streeting, renamed "junior doctors" to "resident doctors" to better reflect their expertise and included commitments to streamline overtime payments and reform rotational training. Yet, by May 2025, tensions reignited when the DDRB recommended a mere 4% rise plus £750 for 2025-26, below inflation and prompting a fresh ballot with 97% approval for action among foundation year one doctors.
NHS trusts are bracing for impact. In Devon, the Royal Devon University Healthcare NHS Foundation Trust urged patients to attend appointments unless contacted otherwise, while East Suffolk and North Essex NHS Foundation Trust warned of "longer-term" disruptions from reallocating consultants and other staff to cover gaps. Barts Health NHS Trust, London's largest, highlighted that resident doctors span from fresh graduates to those with a decade of experience, underscoring their pivotal role in everything from A&E triage to complex surgeries. NHS England's directive to maintain 95% elective activity has drawn criticism from BMA council chair Dr. Tom Dolphin, who accused leaders of prioritizing targets over safety, potentially stretching remaining staff "far too thinly."
Patient advocates echo these concerns. Healthwatch Bromley noted the strike's timing overlaps with rising flu cases, potentially delaying non-urgent care for weeks. On X (formerly Twitter), public sentiment is divided: supporters hailed the action as a stand against "workforce shortages and urgent care conditions," while critics questioned Labour's NHS pledges amid the walkout. One post recirculated footage of past disruptions, labeling it a failure of "change" under the new government.
The broader context reveals systemic strains. Resident doctors' strikes have already cost the NHS an estimated £1.5 billion in lost productivity since 2022, with 1.5 million appointments rescheduled. The BMA links the unrest to a decade of underinvestment: pay disputes mirror those among consultants and SAS doctors, who are reinstating "rate cards" for extra work in protest. Internationally, the UK risks losing talent to countries like Australia, where equivalent roles offer 20-30% higher salaries. Domestically, the dispute coincides with £1 billion in planned redundancies to fund reforms, prompting accusations that funds exist for cuts but not for staff retention.
As picket lines form outside hospitals—from London's Royal Victoria Infirmary to regional centers in Exeter and Thanet—Fletcher urged Streeting to table a multi-year pay deal restoring 2008 levels by 2027, potentially averting future action. "Strikes can still be avoided with willingness for a genuine solution," he said. Yet, with Reeves' budget looming and no talks scheduled, the five-day shutdown signals a deepening rift. GP practices remain open, and inpatient care continues with senior cover, but the human cost—delayed diagnoses, overworked consultants, and demoralized medics—mounts.
BMA leaders frame this as a fight for the NHS's soul: undervalued staff lead to overstretched services, perpetuating cycles of shortages. Government insiders counter that further concessions could inflate costs across the public sector, but analysts like the Nuffield Trust question the BMA's 29% figure, estimating a 4.7% real-terms drop since 2008 using CPI inflation. Whatever the math, the optics are dire for Labour, which swept to power promising to "turn the corner" on NHS woes.
By midday Friday, queues snaked outside striking hospitals, with placards reading "Fair Pay Saves Lives." As the action stretches into next week, pressure builds for compromise. Will Streeting blink, or will this mark the start of a winter of discontent? For patients and medics alike, the answer could define the NHS's trajectory for years.
