There comes a point in any dispute where the question is no longer what more can be offered, but whether the other side is serious about reaching an agreement at all. We are now at that point with the BMA’s Resident Doctors Committee.
After months of detailed negotiations, collaboration, and compromise, the government has put forward a fair, deliverable, and serious offer on both jobs and pay. Our deal would have delivered an average pay rise this year of 4.9 per cent, meaning the pay rise would have increased from between 6.2 per cent and 7.1 per cent for the lowest-paid doctors in their foundation training. Building on the 28.9 per cent pay rise since 2022 that resident doctors have already benefited from, this would mean their pay would be 35.2 per cent higher on average than four years ago – among the highest in the entire public sector.
We’ve also listened to job-related concerns, particularly about career progression and training bottlenecks. That’s why the deal included up to 4,500 additional speciality training posts over the next three years, with 1,000 intended to start this year. We proposed reimbursing mandatory exam fees that cost doctors thousands.
Despite months of negotiation in good faith, the BMA Resident Doctors Committee rejected the deal and immediately announced strike dates designed to cause maximum disruption over the Easter holiday.
A six-day strike is likely to cost well over £250m, and with hospitals forced to divert funds into covering shifts and managing disruption, that money cannot be invested in creating new posts. At the same time, the administrative burden on HR, operational, and clinical teams further pulls focus away from workforce expansion and long-term planning.
We even asked them to put forward an alternative proposal to get the deal over the line – and instead, we received another rejection of the offer on the table.
That matters. Negotiation is a two-way process. If one side cannot even agree among themselves on an alternative, it becomes increasingly difficult to see how meaningful progress can be made across the table. Good faith cannot run in only one direction.
The BMA’s choice to rush to strike action means cancelled appointments, delayed care, and additional strain on colleagues who will be asked to pick up the pieces. We will do our best to reduce disruption, but we cannot eliminate it.
No one should underestimate the pressure doctors are under. I certainly don’t. But nor can we ignore the consequences of repeated strikes on a health service already under immense strain.
The BMA seems to think it should get the benefits of the deal, at the same time as it takes its members out on strike. Putting to one side the absurdity of this position, there is a hard, practical reality that cannot be wished away: some elements of this deal are time-sensitive, and the deal itself becomes unaffordable to deliver if we’re covering the costs of strikes instead of putting money into doctors’ pockets and creating more training posts.
The additional training posts, for example, depend on NHS providers being able to absorb the financial and operational pressures of launching new recruitment rounds. We would have opened applications for an additional 1,000 training posts this month, but with strike action, this becomes operationally impractical and financially unaffordable.
The idea that you can reject a deal while still expecting its benefits to materialise is simply not credible.
Throughout this process, the government has acted in good faith. We have gone further than the independent pay review body. We have compromised on issues like pay structure reform in response to BMA proposals. We have even legislated to prioritise UK graduates for training places – something the BMA itself called for – without using it as leverage in negotiations. This is already dramatically reducing competition for training places by almost half.
That is not the behaviour of a government unwilling to listen.
Ultimately, disputes like this are resolved around the table, not on the picket line. Unlike my Conservative predecessors, I have never closed the door to talks and negotiations.
My priority now must be to support the health service through the impact of further strikes and to prioritise negotiations with nurses and the wider NHS workforce.
The BMA can still choose to step back from strikes, return to serious negotiation, and help us secure a deal that works for doctors, patients, and the future of the NHS.
Because in the end, this isn’t just about jobs and pay. It’s about whether the BMA is prepared to work with us to protect and strengthen the NHS that millions rely on every single day.
Wes Streeting is secretary of state for health and social care
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