UK Junior Doctor Strikes and NHS Pay Dispute (2022–2025)
The UK has experienced a series of junior doctor strikes from 2022 to 2025, stemming from an ongoing NHS pay dispute. This blog post offers a neutral, in-depth examination of why junior doctors (qualified doctors in training roles) have been striking, the impact on patients and the National Health Service, the government's response, and potential solutions to resolve the conflict. Key terms, including the British Medical Association (BMA), consultant, pay restoration, and strike mandate, are explained. We also include example medical ethics interview questions to help sixth-form students prepare for medical school interviews on this timely topic.
Key Terms and Stakeholders Explained
Junior Doctor: In the UK, “junior doctor” refers to any qualified physician who has not yet reached the level of consultant. This includes recently graduated doctors (Foundation Year 1 and 2) and those in specialist training. Junior doctors are fully licensed doctors, but they are still in training under supervision. They form a large part of the NHS workforce (around 75,000 in England as of 2022) and handle day-to-day patient care on wards and in clinics, making them essential to the health service.
Consultant: A consultant is a senior doctor who has completed all specialist training and examinations. Consultants are experts in their field (for example, consultant surgeon or consultant paediatrician) and lead teams of doctors. They supervise junior doctors and make high-level decisions about patient care. (Consultants themselves have also engaged in related strikes over pay, though their pay dispute demands differ from those of juniors.)
British Medical Association (BMA): The BMA is the leading trade union and professional association for doctors in the UK. It represents doctors’ interests, negotiates contracts, and advocates on issues like pay and working conditions. The junior doctors’ strikes have been organised through the BMA’s Junior Doctors Committee. The BMA campaigns for issues such as “full pay restoration” for doctors, and it must legally ballot its members to obtain a strike mandate before any industrial action.
Pay Restoration: “Pay restoration” refers to the BMA’s demand that junior doctors’ pay be returned to the level it would be at if past pay rises had kept up with inflation. The BMA argues that junior doctors have suffered a 26% real-terms pay cut since 2008. In other words, when adjusted for inflation, junior doctors in 2022 earn roughly a quarter less than their counterparts did in 2008. To “restore” pay would require a significant pay increase – initially estimated by the BMA at around 35% – to make up for this erosion. This figure became a rallying point in the dispute.
Strike Mandate: In UK law, for a union to call a strike, it must hold a formal vote (ballot) of its members. If a sufficient majority votes in favour (and turnout meets a legal threshold), the union gains a “strike mandate” – essentially the legal authority and membership backing to initiate industrial action. In the case of junior doctors, the initial ballot in early 2023 saw 98% of voting junior doctors approve strikes, with a turnout of 77%. This overwhelming result gave the BMA a strong mandate to call multiple strikes. Mandates must be renewed periodically (every six months), so additional ballots were held to continue the action through 2023 and 2024 (also returning ~98% yes votes).
Causes of the Junior Doctor Strikes
Junior doctors protesting outside St Thomas’ Hospital in London during a strike (2023). Their placards highlight key issues – one reads “This sign has shrunk by 26%” to symbolise the 26% real-term pay erosion since 2008. Such scenes have become emblematic of junior doctors’ campaign for pay restoration.
The primary trigger for the junior doctor strikes has been pay. Junior doctors argue that years of below-inflation pay awards have left their real earnings far lower than in the past, even as their workloads have increased. According to the BMA, junior doctor pay fell by over 26% in real terms between 2008 and 2022. For example, a newly qualified Foundation Year doctor earns a starting salary in the low £30,000s, which many feel is not commensurate with the responsibility of the job or the cost of living (especially in cities). Doctors report struggling with rising rents, student debt, and bills – some junior doctors even had difficulty affording basics like food or heating during the recent cost-of-living crisis.
Working conditions and workload compound this frustration. Junior doctors often work long, antisocial hours, including nights and weekends, in high-pressure environments. Burnout is common – a General Medical Council survey found that about 1 in 5 junior doctors were at high risk of burnout in 2022, up from 1 in 7 the year before (nuffieldtrust.org.uk). Doctors frequently witness staffing shortages and feel the NHS is understaffed, leaving them overstretched. The COVID-19 pandemic also placed an enormous strain on staff, and many juniors think they have not been adequately rewarded for their efforts during and after the pandemic.
Career progression and retention issues add to the causes. Many junior doctors see limited opportunities to advance or secure training posts in certain specialities, leading to anxiety about their futures. Notably, by 2025, the dispute also highlighted job insecurity for new doctors – about half of second-year junior doctors (FY2) were struggling to find specialist training positions despite workforce shortages. This paradox (doctors without jobs while patients face doctor shortages) has fueled anger, as juniors feel the system is mismanaged.
All these factors have led to low morale. Surveys indicated that a significant number of junior doctors were considering leaving the NHS. In late 2022, a BMA survey found four in ten junior doctors planned to quit the NHS as soon as they could find another job, and a third were contemplating moving abroad (with Australia being a top destination)t. Such an “exodus” is seen by doctors as inevitable if pay and conditions don’t improve, which in turn would worsen staffing for the NHS. The threat of losing so many trained doctors gave urgency to their pay demands – doctors argued that improving pay now is essential to retaining doctors in the NHS and ensuring patient care in the long run.
In summary, junior doctors feel driven to strike as a last resort after years of feeling undervalued. Poor pay, inflation eroding incomes, exhausting working conditions, and a lack of tangible government action created a sense of “enough is enough.” As one junior doctor leader put it, doctors had “taken a giant step forward in restoring value to our profession” by voting to strike. The strikes are a way for junior doctors to voice that the status quo is untenable – both for themselves and, ultimately, for patient care if doctors continue to leave the NHS.
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Government Response and Perspective
The UK government’s position throughout the dispute has been that it recognises doctors’ hard work but must balance pay demands with broader public sector affordability. Government officials have expressed concern that a 35% pay rise (as initially demanded for complete restoration) would be impossible to grant without serious knock-on effects. They cite budget constraints and the risk that significant raises for one group could fuel higher inflation or prompt other public sector workers to demand similar increases. By 2023, Britain was experiencing high inflation and a cost-of-living crisis across many sectors, and the government faced strikes from nurses, railway staff, teachers, and others. The Treasury emphasised that excessive pay rises in the public sector could exacerbate inflation or require higher taxes.
Instead of the unions’ demands, the government initially followed the recommendations of the independent pay review bodies. For 2022/23, junior doctors in England were given a 2% pay increase (which doctors felt was insultingly low when inflation exceeded 10%). For 2023/24, the Review Body on Doctors’ and Dentists’ Remuneration recommended a 6% pay rise plus a £1,250 one-time bonus for junior doctors, which the government accepted. Ministers pointed out that this was one of the higher public sector pay awards that year. In 2023, Health Secretary Steve Barclay noted that junior doctors had a multi-year deal (based on a 2019 contract) that had already delivered a cumulative 8.2% increase by 2023, and that the 2023/24 raise was on top of that. By 2024 and 2025, the government continued to highlight that junior doctors had received substantial raises. In fact, junior doctors’ pay increased by about 28.9% across 2021–2024, according to the Department of Health. For 2023/24 and 2024/25, junior doctors got back-to-back raises (e.g. 5% in 2023 and 5.4% in 2024, plus additional lump sums) – “two years in a row of above-inflation pay increases,” as officials stressed.
However, the BMA countered that these increases came after a decade of pay stagnation and only marginally dented the long-term pay erosion. The phrase “pay restoration” signified that doctors were not just asking for a typical annual raise, but a one-time correction of past underpayment – something the government was reluctant to grant in full. Negotiations between the government and the BMA have been fraught. Early in 2023, the Health Secretary offered to open formal talks on pay only if strikes were called off – an offer the BMA refused, seeing it as conditional and not credible. As strikes escalated, there were periods of stalemate and public war of words. Government officials sometimes took a tough tone – for instance, Prime Minister Rishi Sunak initially declined to meet junior doctor leaders in 2023, and some ministers accused the BMA of being unreasonable or militant in its 35% demand.
From the government’s patient-focused perspective, ministers argue that strikes put patients at risk and that the NHS cannot function correctly under repeated disruption. In 2023, as waiting lists for treatment hit record highs, officials warned that strikes would “risk irreparable harm” by delaying tens of thousands of operations. By 2025, the then-Health Secretary Wes Streeting called the new strikes “unreasonable and unnecessary” (reuters.com), criticising the BMA for continuing industrial action despite already having received pay rises. He stated that “the government simply cannot go further on pay this year”, due to strained public finances and the need to spend limited NHS funds on areas like new staff and equipment rather than significant pay hikes.
Another point the government often raises is the strike mandate turnout. While the strike votes had high percentages in favour, the overall turnout in later ballots was lower. For example, a 2023 renewal ballot had approximately 55% of eligible junior doctors participating. This means roughly half of all junior doctors actively voted to strike (and about half did not vote or voted against). Ministers have seized on this to argue that “most junior doctors did not actually vote for strikes”. They claim the BMA’s position might not represent the views of silent doctors who want to treat patients. (The BMA, however, points out that 55% turnout is still above the legal minimum and that of those who voted, nearly all supported striking – indicating strong sentiment among active members.)
Throughout the dispute, the government’s public messaging has attempted to convey a firm yet open stance towards dialogue. Officials often say they are willing to talk “about anything except pay” (since they consider pay settled by the review body's annual awards). They have shown more willingness to discuss non-pay issues. In late 2023 and 2024, the government offered measures such as expanding training positions, reducing doctors’ paperwork, and improving work conditions, rather than providing additional pay. For instance, it promised to create more speciality training jobs and to address high exam fees and training costs that junior doctors face. The idea was to demonstrate goodwill in improving doctors' working conditions without committing to significant pay rises. Nevertheless, junior doctor leaders have viewed these steps as insufficient “sweeteners,” arguing that without pay restoration, such measures alone won’t stop doctors from leaving.
In summary, the government’s stance is that it values junior doctors but must be fiscally responsible and fair to all taxpayers. It has offered what it calls fair and affordable pay increases (exceeding many other public sector raises) and is unwilling to meet the full 35% pay restoration demand, which it deems unrealistic. The conflict, therefore, has been a clash between what junior doctors feel they morally and economically deserve, versus what the government feels is financially and politically possible. This impasse led to repeated strikes as the dispute dragged on.
Impact of Strikes on Patients and the NHS
Each round of junior doctor strikes inevitably disrupted the health service. During strike days, junior doctors withdraw their labour, meaning hospitals have to cope with far fewer doctors than normal. Consultants (senior doctors) and other staff stepped in to provide cover for emergency and critical services, often working overtime to ensure patient safety. Nonetheless, routine care was heavily affected. Outpatient clinics, elective surgeries, and non-urgent procedures were postponed en masse. The NHS postponed tens of thousands of appointments and operations during each strike. For example, a 5-day junior doctor strike in July 2023 resulted in approximately 61,000 patient appointments being rescheduled that week.
Cumulatively, the impact has been significant. By July 2024, after multiple strike waves, the NHS had rescheduled nearly 1.5 million appointments in total since the junior doctors’ industrial action began in 2023. This figure gives a sense of the scale – behind each number is a patient who had to wait longer for surgery, a cancer check-up, or some other care. NHS leaders have warned that these delays can cause harm. For instance, delaying an elective hip replacement prolongs someone’s pain and immobility; postponing a cancer scan could allow a cancer to progress. Stephen Powis, the NHS England medical director, noted that strike impacts have been felt “even in areas like cancer care,” which historically were protected. He stressed that cancellations of any treatment carry risk, and the NHS has had to triage which appointments can be moved carefully.
During strike days, hospitals often operate at “Christmas Day” staffing levels – meaning there is enough coverage for emergencies and critical inpatients, but most scheduled work is put on hold. While urgent and life-saving care (A&E, maternity emergencies, ICU, etc.) is always provided, patients with less urgent needs are asked to stay away or expect longer waits. Some patients have expressed understanding and continue to support doctors, but others feel anxiety or frustration, especially if their long-awaited operation gets cancelled. By late 2023, public support for doctor strikes appeared to waver – opinion polls suggested support was lukewarm or limited compared to earlier nursing strikes, which had strong public backing. This may be because the disruption from repeated doctor strikes became more apparent to the public over time.
NHS management also incurs significant costs during strikes. Hospitals sometimes pay for expensive agency staff or locum doctors to fill gaps in their rota. Planning for strikes is labour-intensive – appointments must be rebooked (adding administrative burden), and there is a knock-on effect on waiting lists, which have grown. As of 2023–24, NHS England’s waiting list for treatment exceeded 7 million patients, the highest on record. Strikes risk pushing these waits even longer, undermining government targets to reduce backlogs. The Department of Health estimated that the economic cost of the doctor strikes was substantial, not only in healthcare terms but also in terms of lost working days. In September 2024, the government stated that not resolving the dispute earlier had “catastrophic impacts… with over 1.5 million appointments cancelled”. It urged an end to the “chaos” to turn the NHS around.
On the other hand, junior doctors argue that patient care is already in crisis due to staffing shortages and low pay, and that short-term disruption from strikes must be weighed against the long-term damage that would result if doctors continue to leave the NHS. Many junior doctors maintain that they strike with a “heavy heart,” knowing it can inconvenience or worry patients. Still, they feel it’s the only way to press for changes that will ultimately benefit patient care (through better doctor retention and morale). The BMA has also noted that during strikes, hospitals were asked to mitigate risk by postponing elective work in advance, and that clinicians ensured adequate emergency cover was provided via senior staff. Indeed, consultants and other non-striking doctors have managed to keep emergency departments and urgent services open during junior doctor strikes, often at personal sacrifice. There were no reports of patients coming to serious harm directly due to lack of care on strike days, though the full impact on health outcomes of delayed treatments may not be known for some time.
In sum, the strikes have undeniably strained the NHS. They have increased waiting times, added to the workload of non-striking colleagues, and forced difficult decisions about prioritising care. NHS officials likened managing through a strike to dealing with a sudden workforce shortage – hospitals prepared as they would for a disaster scenario or a holiday staffing shortage. Every strike has been followed by efforts to “catch up” on backlogs, with staff working extra shifts to rebook patients. This seesaw is itself exhausting for the workforce. Both the striking doctors and the government express that they don’t want patients to suffer, yet patients have been caught in the middle of this protracted dispute.
Resolution Efforts and Ongoing Developments
After several months of industrial action, there have been steps toward resolution; however, as of the time of writing (late 2025), the issue remains unsettled. In the first half of 2023, junior doctors and the government remained far apart, with strikes escalating from an initial 3-day walkout in March 2023 to a record-breaking 5-day walkout in July 2023 – the longest continuous doctors’ strike in NHS history. The pressure of constant strikes, along with public concern, eventually led both sides to negotiate in earnest.
One breakthrough came in September 2024 in England, when junior doctors voted to accept a new pay offer. By this time, the political landscape had shifted – the UK had a change in government. A newly elected administration moved quickly to end the dispute. The deal reached offered junior doctors a 22.3% pay uplift over two years. This fell short of the original 35% demand but was significantly higher than earlier proposals. In the ratification ballot, 66% of junior doctors voted in favour of this offer, indicating a solid majority ready to settle. The agreement also included some non-pay commitments, like improving the process for reporting overtime hours (to ensure doctors are paid for all extra hours worked). BMA leaders declared this as a hard-won victory – “We have shown what can be accomplished… with a government willing to simply sit down and talk realistically about a path to pay restoration”, the junior doctors’ committee co-chairs said, while lamenting that “it should never have taken so long to get here”. The government, for its part, expressed relief, noting that ending the dispute was necessary as over 1.5 million appointments had been lost amid the strikes.
This 2024 deal effectively ended the strikes in the latter part of 2024 – a period of relative calm followed, with junior doctors returning to work and no new walkouts for several months. The dispute seemed on its way to resolution. Importantly, similar deals were struck in the other UK nations; for example, Scotland offered a 14.5% cumulative pay rise over two years (2022–2024), which Scottish junior doctors accepted, halting their strikes. Consultants (senior doctors) in England also reached a pay deal in 2024 (including a 6% rise and specific reforms), ending their parallel dispute. These agreements hinted that compromise was achievable through negotiation.
However, by mid-2025, it became clear that tensions were not entirely over. The 22% pay uplift, while appreciated, did not fully “restore” pay to 2008 levels. It closed roughly two-thirds of the real-terms pay gap, but inflation and other factors meant doctors still felt behind. Additionally, the issue of training bottlenecks (many new graduates unable to secure specialist training posts) had come to the forefront. In 2025, junior doctors – now officially termed “resident doctors” by the BMA – pressed the government for further action on these fronts. They sought another significant pay boost for 2025/26 and concrete guarantees to tackle the training placement shortage.
Talks between the BMA and the government in 2025 initially tried to avert more strikes. The government maintained that it “cannot go further on pay” in 2025, after the recent significant increase. Still, it did propose reforms such as creating 1,000 new training posts and prioritising UK medical graduates for jobs. When these talks failed to produce a mutually acceptable plan (the BMA deemed the proposals too slow and vague), the junior doctors announced a new wave of strikes in late 2025. From November 14 to 19, 2025, resident doctors in England were set to strike for five days – another dramatic move in this ongoing saga.
As of now, junior doctors (resident doctors) are requesting a roughly 29% pay rise (this figure accounts for what remains of the pay gap after the last deal) to “restore pay to 2008 levels” and immediate measures to address the job shortage for new doctors. The government, led by Health Secretary Wes Streeting in 2025, has criticised the BMA for “rushing into strikes” and insists it will not add more pay this year beyond the ~5% already given. The stage is set for further negotiations, and observers note that a lasting resolution will likely require both sides to compromise. This could mean a smaller additional pay rise, combined with robust non-pay improvements. Some have called for independent arbitration to break the impasse, or a reformed pay review process that both sides trust to give a fair outcome in future years.
Proposed solutions involve not just pay, but also systemic changes. Experts suggest that a multi-year deal could be beneficial – for example, a phased pay increase spread over several years (short of 35% but substantial), coupled with government investment in workforce expansion. The government has already committed to publishing a comprehensive NHS workforce plan (to expand medical school places and training slots), which, if implemented, may alleviate the career logjam in a few years. Additionally, ensuring that doctors feel heard and valued is key – that might include giving junior doctor representatives a role in pay-setting discussions or reforming the pay review bodies (the BMA has called for the doctors’ pay review body to be more independent of government influence).
Ultimately, both junior doctors and government officials publicly agree on one thing: neither side wants prolonged conflict to damage the NHS. Junior doctors have repeatedly stated they would rather be treating patients than on picket lines, and the government acknowledges that a motivated, fairly paid medical workforce is crucial to tackling the NHS’s challenges. The dispute has raised important ethical and practical questions about how we value healthcare workers, how to balance fiscal prudence with fair wages, and how strikes in healthcare should be managed to minimise harm to patients and staff. These questions don’t have easy answers, which is why this topic often comes up in medical school interviews – aspiring doctors are expected to grapple with the dilemmas it poses.
Medical School Interview Questions – Junior Doctor Strikes and Ethics
If you are a sixth-form student preparing for medical school interviews, expect that interviewers might probe your understanding of the junior doctor strikes, as well as your ability to discuss the ethical and professional issues involved. Below are 15 example interview questions related to this topic. These questions are designed to assess your factual knowledge, communication skills, empathy, and ethical reasoning. Consider how you would answer each in a balanced and thoughtful way:
“Why have junior doctors been striking in recent years in the UK?” – (Explain the key reasons for the strikes, such as pay erosion and working conditions, demonstrating your understanding of the doctors’ perspective.)
“What is the BMA and what role does it play in disputes like the junior doctors’ strike?” – (Describe the British Medical Association’s function as a union and representative body for doctors.)
“The BMA asked for a 35% pay rise for junior doctors. Do you think this demand was justified or excessive, and why?” – (Discuss both the rationale for that figure (pay restoration) and the challenges it poses for the government.)
“How do the junior doctor strikes affect patients and the healthcare system?” – (Talk about appointment cancellations, patient safety during strikes, and potential long-term effects on the NHS.)
“What is your understanding of the term ‘pay restoration’ in the context of the NHS pay dispute?” – (Explain what pay restoration means and why junior doctors are seeking it.)
“Doctors have a duty to ‘do no harm.’ Is it ethical for doctors to go on strike, knowing it will disrupt patient care?” – (Explore the ethical tension between doctors’ responsibility to patients and their right to protest for better conditions. Discuss concepts like short-term vs long-term harm.)
“How has the government responded to the junior doctors’ concerns, and what is your opinion on that response?” – (Summarize government actions (pay offers, etc.) and give a reasoned view, showing you can see both sides.)
“If you were the Health Secretary, how would you address the junior doctor pay dispute?” – (Outline steps you might take, such as negotiating in good faith, phased pay increases, improving work conditions, or using mediation – demonstrating problem-solving.)
“Junior doctors in Scotland and Wales have had different approaches to pay deals compared to England. What do you know about this, and does it offer any lessons?” – (Mention, for example, that Scotland negotiated a deal earlier, and discuss what that might mean about compromise.)
“Some people argue the junior doctors’ strike is more about principle than money. What principles do you think are at stake?” – (Consider issues like feeling valued, maintaining the NHS workforce, and doctors’ morale.)
“During a strike, how is patient safety maintained? What would you say to reassure a patient who is worried about the impact of strikes?” – (Explain “Christmas Day cover” (emergency care still provided) and how consultants cover urgent work, showing empathy and understanding.)
“Do you think there should be limits on strikes in healthcare (for example, legally requiring a minimum level of service or banning strikes by certain staff)? Why or why not?” – (Discuss the balance between the right to strike and patient safety. This assesses ethical reasoning and understanding of law.)
“Aside from pay, what other changes do you think junior doctors are seeking to improve their working lives?” – (Talk about working hours, workload, mental health support, training opportunities, etc.)
“How do you think prolonged disputes like this affect the public’s trust in doctors and the medical profession?” – (Consider both potential negative impacts and why many public members still support doctors. Show awareness of professionalism.)
“Imagine you are a junior doctor during a strike. A patient on the ward asks you if you will be striking and why. How would you respond?” – (This tests communication and ethics – you should show you can explain your reasons calmly and put patient care first while respecting colleagues’ actions.)
Preparing answers to questions like these will help you articulate a nuanced understanding of the junior doctor strikes. Remember to stay neutral and consider both perspectives: the junior doctors’ plight and motivations, as well as the government's and patients' points of view. Interviewers are not looking for a “right” answer on such a complex issue, but somewhat balanced reasoning, empathy, and ethical awareness. By staying informed on current healthcare debates and reflecting on the principles involved, you will be well-equipped to discuss topics like the junior doctor pay dispute in your medical school interviews – demonstrating the insight and integrity expected of a future doctor.
Sources: Recent NHS, BMA, and news reports on junior doctor strikes were used to ensure accuracy:
NHS England data on strike impact england.nhs.ukengland.nhs.uk
BMA statements on pay cuts and strike votes bma.org.ukbma.org.uk
Reuters and Guardian news articles on the dispute’s developments up to 2025, among others. Each provides context to the facts and figures discussed above.
