Doctors on Strike: A Q&A on the BMA Pay Deal and What It Means for Us
Written By Helen Zhang & Azsvin Mariathasan
(note: Written in Winter 2025)
In this interview, we sit down with Azsvin, a dedicated advocate for all things politics, especially medical politics and its impact on the NHS. As the politics lead at Healthcare Management and Politics Society (HeMP) at UCL, and having regular involvement with the British Medical Association (BMA) including (attending key BMA events such as the Medical Student Conference and the Annual Representative Meeting last year), Azsvin shares a unique perspective on the evolving landscape of medical politics and the future of the NHS.
Today we discuss the recent BMA pay deal. What is it, what has happened and what does it mean for us as medical students?
Let’s start with the big picture. Who was involved in the pay deal, and who pushed for it?
The pay deal was primarily advocated by the Doctors Votes movement, which was this almost “splinter” group within the BMA that sought to challenge some of the more institutional forces that had traditionally held power in the organisation and led negotiations, such as for the junior doctor contract.
One of their key objectives was full pay restoration (FPR), which aimed to bring wages back in line with inflation. This is a common practice in the private sector but, unfortunately, not in the state sector due to austerity measures (budget cuts) introduced by various governments since 2010.
Another significant objective was advocating for the renaming of ‘junior doctors’ to ‘resident doctors’. The aim was to better reflect the advanced skills and responsibilities of many doctors in this category—some of whom have progressed to roles like Senior House Officer. This terminology aims to reduce public confusion about why ‘junior’ doctors are paid more, acknowledging their expertise and experience.
What was the motivation behind the timing of the Doctor’s Vote movement?
On the whole, the timing was influenced by the goodwill towards healthcare workers coming out of the COVID-19 pandemic. Initiatives like ‘clap for the NHS’ highlighted the value of a publicly funded healthcare system and how close we were to losing it, which brought significant respect to the medical profession.
In a sense, the strikes were an effort to translate this goodwill into a sustainable future for medical professionals. Of course, each strike risks eroding some public support, but there was a recognition that goodwill alone couldn’t compensate for worsening working conditions, stagnant wages, and declining morale.
So, what did resident doctors aim to achieve through this deal?
The ideal outcome was FPR, which would have meant a 26% wage increase to match inflation. Inflation has been incredibly high recently, and you can see the impacts of that in terms of political movements (incumbent parties lose votes during times of inflation).
However, the actual pay deal secured only a 22.3% increase, spread over several years. While this is a step in the right direction, many feel that more could have been achieved had we played our cards better.
So why was the deal accepted now? (What were the arguments for and against accepting it?)
Speaking from personal experience, I can understand the reasoning behind it. The Junior Doctors Committee (JDC), led by figures like Rob Laurenson and Vivek Trivedi, advised both the public and BMA members that the pay deal was worth accepting, partly due to prolonged striking being unsustainable. People don’t come into medicine to strike. We enter the profession to make a meaningful difference, and these strikes are very much a last resort.
You could sense the goodwill eroding, not just among the public, but also within the medical profession itself. There was growing unease among various branches of practice, even junior doctors themselves were questioning the ethics of such prolonged strike action.
So, I fully understand the argument of fatigue and a loss of momentum made accepting the pay deal seem like the right choice at the time.
Are there any arguments for rejecting the deal?
Yes, the decision to take the deal was partly based on an assumption that Labour would win the next general election with a strong majority (which they did) and an extended honeymoon period to implement reforms. However, recent developments such as Labour’s recent drop in polling and Keir Starmer’s ratings falling below Rishi Sunak’s according to in some sources suggests that the anticipated political environment may not materialise and that these assumptions were overly optimistic.
Additionally, leaked texts informed us that the JDC’s strategy (termed “bank and pay”, where strikes are used to secure incremental deals, waiting for a period then striking again) relies heavily on public goodwill, which may not hold indefinitely. This phrase, “bank and pay”, will be huge in the resident doctor movement in the next few years.
With Labour having lost some of their goodwill and approval ratings in mixed territory, perhaps we didn’t have to worry about the Labour majority as much, leaving us a bit of wiggle room to get a slightly better deal. In cases like this, every little bit does count.
In your opinion, do you think striking action was carried out efficiently?
In my personal opinion (this isn’t the official stance of the BMA or other organisations), we did play our cards poorly in certain instances. Take, for instance, calling for strikes the weekend before the general election. From the public’s perspective, and even that of many medical professionals, this was a misstep. There was effectively no government at the time so it seemed like we were striking to nobody. It even gave the impression of indirectly aiding a political party, which damaged the profession’s impartial image. This move didn’t win us any public goodwill or strengthen our position in negotiations.
Striking needs to be strategic and carefully measured because each action risks eroding public trust. There’s only so much faith we can ask of the public, and unnecessary strikes (like the ones before the election) burn through goodwill unnecessarily.
Even the messaging had issues. Do you remember the campaign claiming a coffee barista makes £14.10 an hour: more than a junior doctor? That was highly controversial and didn’t help the perception of snobbiness within the medical profession. In a campaign like this, the goal is to appeal to the general public, not to alienate them, as that advert did.
These small missteps can have significant consequences because during strike processes, you need to be unimpeachable. Even a single slip-up can harm the cause.
I recognize how challenging it is for the JDC committee. There’s immense pressure, and perfection is unrealistic. However, there’s only one opportunity to get these things right, and I do question the rationale behind some of these decisions.
Can you explain the BMA’s background, its structure, and its role in strikes?
Historically, the BMA primarily functioned as a professional association (similar to what RUMS is to UCLMS), offering guidance to clinicians rather than a trade union. Before the establishment of the NHS in 1948, clinicians largely controlled healthcare, so strikes were unnecessary because doctors were in charge of their own work conditions. Interestingly, the BMA once had more influence over the General Medical Council (GMC).
With the creation of the NHS, the government became the employer, and the BMA struggled to adapt. Unlike robust trade unions for other professions, such as rail workers or miners, the BMA was slow to develop effective mechanisms to protect doctors’ autonomy and wages. Over time, this has led to a decrease in doctor autonomy in clinical practice, increased GMC oversight and lowered wages for doctors as the government capitalised on the BMA’s lack of proper union-like representation.
Today, there’s a shift in terms of factions within the BMA. A growing faction, led by movements like Doctors’ Vote, advocates for a stronger trade-union approach. You also have older doctors who want to prioritise maintaining the profession’s respectability, which was a crucial factor in allowing strikes to have gone on for so long and sustaining the public support during. These two movements sometimes clash on a lot of different topics, with extreme positions on both sides. For instance, some resident (junior at time) dDoctors wantedwanting to sell assets like the BMA house to create a strike fund to support industrial action; whilst some of the older doctors wanted the BMA house to be exclusive strictly to BMA committee and events.
So both actions do have people on the extremes, but in my view, the future of the BMA likely lies in finding a balance between these perspectives; combining the best of a professional association with trade union principles to adapt to the modern challenges of how best to represent doctors’ interests effectively.
What has been the impact of strikes on the public opinion?
Generally speaking, clinicians had significant goodwill from their integral role in the pandemic, and that respect largely remains. Medicine is almost unique in how highly regarded it is as a profession.
While I do think there were mistakes during strike action that certainly causedcause frustration, I doubt it was enough to damage future movements or action from the BMA. Overall support for doctors has remained stable and, at the end of the day, people do recognise the essential role of doctors.
For anyone interested in following NHS politics, where could they go for more information?
With medical politics and NHS politics in particular, it requires careful attention. Headlines on platforms like the BBC provide the big picture but it’s important to look at the foreground and trace that back to the background through the noise. Importantly, stay up to date. Resources like the BBC Health Section are a good starting point for staying updated.
Also, attending events held around London such as those hosted by HeMP or the BMA give you a valuable opportunity to interact with the people actually involved in the processes, such as policymakers and activists who are driving the change in the healthcare system that creates the headlines that you read about.
Closing remark
The NHS is at the heart of British society, and I think the NHS is going to be what the next election is most likely fought on. As medical students and future doctors, we are in a pivotal position in terms of how we can leverage our strength in the future.
Read the rest of the edition here
