The junior doctors have balloted for more strikes, there are no talks that anyone wants to talk about and the scalpel of Damocles hangs over NHS waiting lists.

Doctors and pay. Always a problem. In 1957 a Royal Commission concluded;

‘… increased salaries would not attract more young people to medicine, or dissuade existing staff from emigrating.’

Nevertheless, the Wilson government jacked up their pay by 30% and established an independent review body to;

‘… prevent pay disputes from disrupting the work of the NHS, through even-handed analysis of data… and to assure the taxpayer, doctors were not earning too much.’

There have been skirmishes since but the facts speak for themselves;

• According to the Medical Schools Council, in 2021 courses were oversubscribed 3-1: 28,690 applicants for 9,500 slots.
• Training is complicated by the cost, university and clinical placement capacity, and the number of clinically qualified academic staff who design and deliver courses.
• Every year training places are capped at around 9,500 places.
• The NHS workforce plan, plans to increase medical school places to 15,000 by 2031.
• Increasing the number of medical students by 5,000 costs about a billion.

There’s no shortage of applicants…

…it’s true, the number of doctors leaving has increased in the last year. However, the proportion of licensed doctors leaving has actually returned to pre-pandemic levels of just under 4%.


… renumeration compares middle-ish with other countries.

But, there are still not enough doctors. NHS turnover figures for England (Para 4.1) tend to show more people joining than leaving the NHS. Despite this, the level of vacancies has increased in recent years, because the total number of roles has grown.

Not much has changed since 1957!

Strikes? Junior doctors retain support from half of the public.

By contrast, strike action by consultants has the least public support

Nevertheless, thousands of people have stoically put-up with being bounced off waiting lists in support of doctors trying to level up the value of their inflation-hit wage packets.

On Friday the BMA announced 83% of consultant members, in a 62% turnout (probably just over 20,000), had quietly decided to accept HMGs offer to end their strike.

Dr Vishal Sharma, the chair of the BMA consultant’s committee, said something about this being;

‘…the end of the beginning’

and his concern was

‘…for patients and the future sustainability of the NHS.’

Yea, right. The truth? More like the consultants read-the-room… knew they couldn’t rely on continued public support.

The settlement?


If you acquiesced in the consultants’ strike in the belief that is was in pursuit of equity and fairness, helping highly qualified young men and women to get a fair reward for their years of selfless study…

… think again.

If we use the BMA’s own numbers from the 2023/24 pay-deal-scale (green table) that includes the 6% in the first award and we create our own ‘average-consultant’ with an income of roughly £115,000…

… to keep up with inflation, that level of pay would have to be increased to £119,370… up by £4,370.

… if pay were to be increased in-line with current average-pay-growth it would mean an increase of £6,440, taking it to £121,440.

The BMA have failed to get close to pay restoration…

… this increase would only take them to £118,220. Meaning; after a year of argy-bargy over pay-restoration, our ‘average-consultant’ would be about three-grand out of pocket.

But, but, but…

… our ‘average consultant’ doesn’t exist. It doesn’t work like that. The BMA have agreed a new pay-banding system, based on years served; 0yrs to +19yrs.

In fact, Band 2yrs, get no uplift at all, and Band 3, just 2.85%.

Wait for it…

… if the plan was to stop young consultants in Bands 4-7yrs, leaving the NHS for the sunny shores of Australia, they only get 2.85%… and anyway, consultants are the group least likely to leave. (Chart)

… if the the plan was to give established consultants with years of experience and many of whom are probably earning a nice few quid from private practice, even more money… they have.

Bands 14-18yrs get a whopping 10.59%

Even from this distance you can see which end of the trough is the deepest.

The BMA’s detailed ‘explainer’ (Page 4) claims the deal ends the gender pay gap, dunno how… and confesses the ‘investment’ is not applied evenly. Unless the BMA have found a way to reduce the length of a year, I can’t fathom why consultants have agreed this.

It looks to me, they’ve just thrown-in the towel.

The BMA are claiming victory in-so-far-as they’ll have a say in the make-up of the DDRB and a tweak in their terms of reference… but if future governments refuse to honour their recommendations… as has happened in the past… they’ve achieved nothing. No guarantees.

I have no idea why consultants who probably lost a chunk of money whilst striking, have settled for a deal where;

• consultants with 2 years service get no increase at all, above the original award,
• years 3-7 get an extra 2.85%
• those with 8 and more years get additional awards upwards of double that,
• with years 14-18 scooping-up almost 4 times as much…

… this is a redistribution that makes well paid, older doctors better paid, younger consultants scarcely better off and the waiting lists no shorter.


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