Junior doctors across the UK are proposing nation-wide strikes in early January. This blog post will be exploring why junior doctors want to strike and what impacts these strikes may have on wider society.
The British Medical Association have outlined 3 main aims to ballot for industrial action which are as follows:
Essentially, junior doctors are balloting to strike because they feel that they are being undervalued for the work they do and this feeling has been exacerbated by working tirelessly throughout the pandemic, only to be rewarded by weekly clapping rather than a pay rise. In a survey conducted by the BMA in 2021, 90.7% of junior doctors felt the government does not value their work and 96.6% felt that the 2% pay rises in August 2021 were inadequate for the work being done.
These feelings of inadequacy can lead to junior doctors being driven to the private sector or working in other countries in the hope of receiving better salaries and working conditions. These difficulties are aggravated by the rapidly increasing cost of living in a society where inflation is at a record high. Junior doctors have added costs to worry about besides their rent and growing bills, such as their annual fee to the GMC (around £420 per year), paying sometimes over £500 to sit exams to help them progress to the next stage of their training and transport and parking costs.
On top of that, the tuition fee and maintenance loan debt from Student Finance England can often be over £80,000 after completing medical school, which is difficult to pay off given interest rates. Medical school graduates on the average salary they receive today are unlikely to be able to repay this debt in full for a long time if at all.
Junior doctor Emma Runswick, who originally proposed the motion for industrial action, discussed pay restoration and said:
‘We should not wait for things to get worse. All of us deserve comfort and pleasure in our lives. Pay restoration is the right, just, and moral thing to do… Do not be tempted to accept a pathetic future for our profession. We are worth more.’
A junior doctor is any doctor that isn't a consultant or GP.
The current pay for a foundation doctor in their first year (FY1) is £29,384 and for a foundation doctor in their second year (FY2) is £34,012. The maximum pay for a registrar whilst they are training is £53,132. Junior doctors have faced drastic pay cuts since 2008 and have seen their real term pay decrease up to 30%.
As pay has not kept up with inflation rates, currently junior doctors in England have received a real terms pay cut of 26.1% compared to pay in 2008/09. Junior doctors are ready to take action as they certainly don't feel they work 26.1% less and in fact, many feel they experience harsher work conditions than doctors did previously.
If you want to read more on how much doctors earn in the UK, you can read this article by Dhillon here: https://medmentor.co.uk/blog/what-happens-after-medical-school-in-the-uk
To take any industrial action, such as a strike, junior doctors must first ballot. A ballot is a vote by members of a trade union (in this case the union is the British Medical Association) to decide whether they will be taking industrial action. The BMA ballot to strike opened on 9th January 2023 and only junior doctors that are members of the BMA will be able to vote. If successful, there will be a 72-hour strike in March.
There are some guidelines that the BMA need to follow before they undertake any strike action. To be considered, the ballot requires a turnout of 50% of those who are eligible to vote. However, because the profession of junior doctors is considered to be ‘important public service’, the Trade Union Act of 2016 requires that 40% of those who are entitled to vote must vote in favour of the strike for it to be considered.
Furthermore, to take part in the strike, you need to be contracted with an NHS employer. You cannot take part in the strike if you are scheduled to work for a non-NHS employer on the days of industrial action. You need to respect the other contracts that you have and must not breach them. Junior doctors are allowed to take part in the industrial action, even if they are overseas, if they are employed by the NHS. Junior doctors who are not members of the BMA can still take part in strike action but will not be protected by the union. Medical students cannot take part in the industrial action because they do not have a current contract with the NHS.
If junior doctors are planning to take part in the strikes, they should expect to not be paid on the days of industrial action and therefore they should consider planning in advance, particularly if they are struggling financially. BMA members will also be supported by the union and protected from unfair dismissal from their employers for 12 weeks, starting from the first day of the industrial action. The BMA can still help support members after this 12-week period if they are facing any sort of issue regarding taking part in the industrial action.
The strikes are most likely to occur on picket lines outside hospitals, as these are deemed to be most effective when carrying out any industrial action.
On the days junior doctors strike, patients will still be sick and hospitals will still be running. Consultants will be asked to step down to cover the gaps on the ward left by the junior doctors striking. This means that on a cardiology ward for example, where there may usually be 5 junior doctors (including foundation doctors, IMTs, and registrars), you may have a couple of cardiology consultants filling in those roles. Whilst this may seem great given the experience consultants offer. it means these consultants can't do what they otherwise should be doing. For example, the consultants may have to cancel their clinics or elective lists in order to cover the wards.
Junior doctors went on strike for the first four months of 2016 ,striking for periods between 24 and 48 hours. They took part in industrial action on 12thJanuary, 10th February 9th-10thMarch and 26th-27th April. The last strike in April was the only strike that also involved withdrawing emergency services.
The reason for this strike was because junior doctors objected to a new proposed junior doctor contract in England. The BMA posed a legal challenge to the new contract, focussing on the equalities impact and whether the government paid any regard to it. In the new contract, there was a proposed 13.5% increase to basic pay however, a reclassification of what is considered ‘unsociable hours’ where junior doctors receive an increased level of pay. In addition to this, guaranteed pay increases that were linked to the time you spent in the job were also proposed to be changed and instead be connected to how you progress through the training stages. Because of this, doctors would be losing pay overall and this is what led them to strike.
We can try and predict the impacts of a strike by looking at the impact that the strikes in 2016 had on patient care, although impacts may be worse now as the NHS is in a very precarious state after the pandemic.
There was a study carried out by the National Institute for Health and Research which spanned over 12 weeks. In comparison to normal numbers, during the strikes, there were 9% fewer admissions, 7% fewer accident and emergency attendances and 6% fewer outpatient admissions in hospitals. However, in the April strikes, there were 15% fewer admissions, 8% fewer emergency admissions and 20% fewer planned admissions. Throughout all four strikes, nearly 300,000 outpatient appointments were cancelled by hospitals which is 52% higher than the expected volume. Some regions were disproportionately affected by this with Yorkshire and the Humber, Southeast Coast and London cancelling almost 68% of appointments and experiencing larger proportions of missed appointments as well. Although the numbers of death did not change significantly, you cannot judge the changes in numbers of death based on the people who did not seek out care. There may have been people who suffered as a result from missing their appointments and being unable to receive care within hospitals.
However, it is also important to consider what may happen to the quality of patient care if junior doctors do not strike. The numbers of junior doctors who are burnt out will only increase and with the NHS already being under so much pressure, understaffing will only exacerbate the problem. Rather than the short-term impacts that the strike had on the numbers of appointments being cancelled in 2016, if junior doctors do not strike and demand better working conditions for themselves, the NHS and patients across the board could suffer long term detrimental impacts on their workforce.
It is not only junior doctors that are striking over the next few months. From the 20th December, there are coordinated strikes in England and Wales where nurses, ambulance workers and hospital staff will be taking part in industrial action. These healthcare workers are also striking for better pay as the pay rise they have been offered is markedly lower than the rate of inflation within the cost of living crisis we are facing. These strikes are looking to leave even the basic healthcare services severely understaffed. Patients should be expecting ‘Christmas Day’ levels of staffing and there have been talks between Union representatives and the government to try and avoid loss of life.
These strikes will put pressure on the government and mean that the proposed junior doctor strikes in January may be seen as more significant. The NHS is essential for our country and if the healthcare workers, the people who keep the NHS afloat, are burnt out and unable to provide their best standard of care, the NHS cannot keep providing free care at point of access. This defeats the very purpose of why the NHS was set up in 1948. Therefore, the government needs to listen to the pleas of healthcare workers for pay rises, so they are paid in accordance with what they deserve for the work that they do.
Author: Fateha Khawaja
Editor: Dr Latifa Haque