Since its insurrection in March 2023, the dispute between successive governments and the BMA has struck repeated blows to NHS waiting lists, DHSC budgets, and public trust in the profession. The simplicity of the argument put forward by the BMA is its appeal to members: pay has not risen in line with inflation - you are not worth less than doctors in 2008. But despite inflation-busting pay rises over the last three years, discontent remains and strikes persist. Is pay really the underlying issue or a simple vent in a complex, overheating system?
Recent GMC training surveys paint a damning picture of the outlook for resident doctors pursuing training. Over half (56%) of trainees say they receive no mentoring support other than mandated meetings, while 48% of supervisors surveyed reported not being able to use protected training time for its purpose. Both 61% of trainees and 47% of trainers were found to be at moderate-to-high risk of burnout. On the ground, consultants are reporting that adequate training is no longer possible, with one commenting that ‘overwhelming service needs mean senior and juniors are pulled in different directions, there's no time to supervise trainees and build relationships'.
For graduating doctors entering the workforce the situation is even bleaker. Competition ratios for training jobs are skyrocketing, having increased by 3.5x for GPs, 3.7x for surgeons and nearly 6x for emergency doctors in the last 10 years. Competition ratios for emergency medicine now stand at 14:1. The prospect of applying for these jobs where training quality is consistently declining leaves doctors searching elsewhere – the Royal College of Physicians surveys suggest one-third of doctors plan on working abroad. The majority cite better financial incentives, working conditions and work-life balance as key reasons - popular destinations such as Australia and Canada offer better annual salaries for lower working hours.
Some credit must be given to the Government for recognising these issues. The 10-Year Health Plan states that ‘the experience for doctors… has deteriorated significantly over recent years' and commits to ‘tackle bottlenecks in medical training pathways'.
However, there is a failure to grasp the true scale of the issue. There were 30,000 applicants for 10,000 training posts this year leaving 20,000 doctors without a training post - the commitment to deliver an extra 1,000 jobs over the next three years is an umbrella against a hurricane. Streeting's latest offer of doubling this figure will not qualm the worries of the 10,000 new doctors entering the system each year.
To spin it differently, solving this issue presents a concrete non-pay related solution to ending industrial action and the consequent service disruption. DHSC estimates the coming strike will cost the NHS £240m; losses the NHS simply cannot afford.
Simultaneously, the BMA argue doctors should not have to sacrifice themselves for the sake of the NHS. The Government often cites that meeting BMA pay demands is not fair to other healthcare workers, ie they're concerned caving to one union means caving to them all. Proposing realistic solutions to tackle the ongoing training crisis not only avoids this but kills two birds with one stone. Investing in the training of doctors promises future service provision as while satisfying the current workforce rather than paying doctors more for the same service. Failing to tackle the training issues will result in higher levels of burnout, haemorrhaging more nationally trained doctors to the global healthcare market and risking a workforce crisis even worse than today's in 10-15 years' time.
Should the Government decide to implement this plan, its slogan of ‘Delivery, Delivery, Delivery' must ring true. Reform to the exception reporting system is set to come into place this February, 19 months after the deal was struck. Similar delays in future non-pay related items will erode what little faith the workforce has left in Government and inevitably lead to further action. The momentum on the wards is changing - the chief concern among resident doctors is now ‘will I have a job' rather than ‘how much will I get paid'. Campaign media from the BMA is shifting towards competition ratios rather than pay disputes. With both sides at a stalemate, now is an opportunity for the Government to get ahead of the curve and provide a tangible, long-term, non-pay related offer to its workforce. Failure to do so and continuing in this war of attrition will hurt NHS budgets, resident doctor trust and ultimately patient care.
Dr Tej Pradhan is an independent health policy journalist and current NHS resident doctor. Find more of his work on his Instagram @drtejpradhan.
