NHS on life support as strikes continue

Currently, resident doctors at different levels of seniority earn between 38,831 pounds and 73,992 pounds ($52,146 and $99,363) a year for a 40-hour week. When comparing doctors' pay with salaries across the wider economy in England, average total earnings for first-year doctors — the most junior level — is above the median, so above the halfway point for all workers' pay, the Nuffield Trust health think tank found in its July explainer.

Total earnings consist of the basic salary and also extra payments covering, for example, on-call duties, night shifts, weekend work and payment for working longer hours, as well as geographical allowances.

These figures have confused — or even irritated — members of the public, with comments on X under BMA strike-related posts saying doctors are asking for too much.

Some people have even argued that doctors' right to strike should be "taken off" them.

"You are there to save lives," one comment said. "You should not be able to strike, it's as simple as that."

Opposition to the resident doctors' strikes has reached a record high, according to the latest YouGov polling, with 53 percent of the British public against them.

That said, Amie Brillu-Ogden, a Briton who lives in Bath, said she supports the strikes because resident doctors are not being paid enough.

"Inflation has been tough, and all public servants should be getting an increase of more than inflation; otherwise, they are essentially getting a pay cut," she said. "I don't believe the strikes are the reason the system has deteriorated. Often, they are used as a scapegoat to deflect responsibility from the government."

The BMA has argued that resident doctors' basic pay is 20 percent lower in real terms than it was in 2008, even after the 2025 increase. Real terms figures are adjusted for inflation and reflect the true value of money in terms of what it can buy. Doctors say pay rises since 2008 simply have not kept up with the rising cost of living.

The Nuffield Trust explainer estimates that average real-terms earnings for 2025-26 have eroded by between 4 percent and 10 percent since 2010-11.

Pay analysis can be endlessly contested. The choices of baseline year, the way inflation is calculated, and other data can create very different pictures.

For example, measured against the consumer price index, or CPI, resident doctors' pay has fallen by just 1.6 percent since 2010. But when using the retail price index, or RPI, it has decreased by 15.5 percent, a Nuffield Trust analysis noted.

The government uses the CPI for its calculations, which is also an internationally recognized method. Trade unions, including the BMA, prefer using the RPI as a measure of the actual affordability burden felt by working people, because the RPI captures housing costs, as well as student loan interest costs, which are important to many doctors.

The RPI lost its status as a national statistic back in 2013.

The UK Office for National Statistics, or ONS, said: "Our position on the RPI is clear: we do not think it is a good measure of inflation and discourage its use."

The BMA is demanding a multi-year pay deal toward "full pay restoration", which would amount to a 26 percent rise in basic rates on top of the 28.9 percent increase already received.

Is that achievable? Liu said it "depends on practicability". The Nuffield Trust estimates a 1 percent uplift for resident doctors in 2025-26 would add roughly 51 million pounds to the NHS wage bill.

"What I can say is that it is not really about pay; it is about a trifecta of issues that resident doctors are not happy with," Liu said. "People like to talk about pay because people understand it. But two other very important factors are less talked about and less understood: career progression and rota gaps."

Bottlenecks

Many resident doctors cannot go on to train in specialties after they finish their first two years as foundation doctors because there are not enough places in the programs, Liu said.

This year in the UK, more than 30,000 applicants competed for around 10,000 places, according to the BMA, which said the unemployment crisis not only stunts resident doctors' careers but also deprives the NHS of the workers it needs to reduce waiting list.

"In some years in cardiology, there were only two places in the whole of London," Liu said. "People came in. They knew at the age of 16 they wanted to be a brain surgeon or a gynecologist. They just can't do that … You simply cannot get into the specialty, and that takes people's passion away."

Meanwhile, the NHS has been short-staffed on a daily basis, and resident doctors face an intensifying workload to cover rota absences, Liu said.

The BMA said back in 2018 that 70 percent of resident doctors reported working on a rota with a permanent gap, and more than two-thirds of medical professionals had been asked to act up into more senior roles to fill the gaps.