Resident doctor strikes during a flu crisis

What this episode is about

The discussion revolves around the ongoing strikes by resident doctors in the UK amidst a flu crisis, highlighting their concerns over job security, real-term pay erosion, and the urgent need for government negotiations. Despite facing criticism from political leaders, doctors argue that their industrial action is a necessary response to unresolved issues affecting their profession and patient care.

Key takeaways

• Negotiating before strikes: a novel approach to healthcare advocacy that's shockingly ignored by officials.
• Winter flu warnings feel like government scaremongering; doctors on the ground keep the NHS afloat.
• Striking for survival: when letters go unanswered, sometimes a protest is the only way to get a seat at the table.
• Real-term pay cuts over 15 years? Doctors aren't just striking for themselves but for the NHS's future sustainability.
• Calls for dialogue overshadowed by incendiary rhetoric; it seems 'self-indulgent' isn't how doctors view advocating for patient care.

Who speaks in this episode?

• Jack Fletcher (Host) · 32 min speaking

What is discussed, and when

1. 0:00 – 5:00: Jack Fletcher, BMJ
2. 5:00 – 10:00: NHS England
3. 10:00 – 15:00: NHS England
4. 20:00 – 25:00: NHS England

Notable quotes from "Resident doctor strikes during a flu crisis"

• Welcome to a special BMJ interview. our guest today is Jack Fletcher, who represents resident doctors for the BMA.

  about Jack Fletcher · at 1:13

• We've got experts like Jonathan Vanam out there this morning essentially saying that we need to stop the well I called it scaremongering at the weekend ask you about that.

  about Jonathan Van-Tam · at 5:20

• Thank you. And let's just turn to pay finally. what are you actually asking for now? I mean Wes Streeting said before the election that he would deal with junior doctor pay. is he in your view he's not delivering what he promised clearly?

  about West Streeting · at 24:51

Who and what is mentioned in this episode?

People

• Jack Fletcher — Person · Main guest · 2 mentions · first at 1:15
  Primary interviewee representing BMA resident doctors, explaining the rationale for strike action and negotiating positions on pay erosion and training/jobs bottlenecks.
• West Streeting — Person · Referenced government decision-maker / critic · 6 mentions
  Cited as the political figure criticizing the strike and as the health secretary making offers on training places and pay; central counterpart in negotiations from the doctors' perspective.
• Jonathan Van-Tam — Person · Referenced expert · 4 mentions
  Invoked as an external expert voice urging politicians to 'dial down the rhetoric' about flu pressures, supporting the guest's claim of scaremongering.

Companies & orgs

• BMA — Company · Business focus · 5 mentions
  Represents resident doctors in the UK and is central to the discussion about strikes and negotiations with the government.
  Welcome to a special BMJ interview. our guest today is Jack Fletcher, who represents resident doctors for the BMA.
• NHS England — Company · Business focus · 4 mentions · first at 6:07
  The primary healthcare provider in England, involved in the negotiations and discussions about doctor strikes and healthcare pressures.
  We've heard warnings from the government and NHS England that of unprecedented waves of super flu. So what we are seeing is the numbers aren't matching the rhetoric that's coming out.
• BMJ — Company · Business focus · 1 mention · first at 1:13
  The platform hosting the interview, providing context and framing for the discussion about doctor strikes.
  We're speaking on the first day of a five-day strike by resident doctors in England. the government response has been unusually blunt. West Street has called the action self-indulgent,.

Full transcript with timestamps

0:00 Can we talk? Can we get around the table? And can we get a deal done that fixes this absurd jobs crisis for doctors in the UK? And also addresses the real terms pay erosion that doctors have faced for the last 15 years in the face of more recommended real terms pay cuts that the government are pushing forwards at the moment. There are no strikes planned. There are no dates currently in the diary for further strike action. Can we get round the table? that letter was not responded to.

0:31 We then announced industrial action and only after that did we then start to get things like offers.

0:37 We've heard warnings from the government and NHS England that um of unprecedented waves of super flu. So what we are seeing is the numbers aren't matching the rhetoric that's coming out of the politicians and that is real scaremongering and I think I'd far rather be spending my time and energy sat opposite the secretary of state or his team hashing out a deal to see an end to industrial action than trying to think about when we're going to plan our next strike. Welcome to a special BMJ interview. Uh our guest today is Jack Fletcher, who represents resident doctors for the BMA.

1:21 Uh we're speaking on the first day of a five-day strike by resident doctors in England. Uh the government response has been unusually blunt. Um West Street has called the action self-indulgent, irresponsible, and dangerous. And Kier Starmer says it's irresponsible. So Jack, welcome. Um, should we start with the language first from government? [clears throat] Self-indulgent irresponsible dangerous. Why are they wrong? Uh, yeah. So, I think there's some there's been some interesting language that's been out and about on the uh media and in the airwaves over the last few um weeks and months to be honest. And I think what's really important is to take a step back and think about the people who I represent and my colleagues who are medical professionals who um provide patient care who until today were keeping the ship running essentially and who will be keeping the ship running over Christmas into the new year and

2:21 also then going forward. And I think when we see language like that, when we have asked to negotiate repeatedly to bring an end to this dispute, when we have indicated that we are willing to negotiate in a reasonable way and that has not been met with even a reply, I think that is the really irresponsible part rather than focusing on the actions of doctors who are out there usually in A&Es in acute assessment units who are the first people who will be on call if you have a surgical emergency overnight and I just think that is the really irresponsible part.

3:02 I mean the NHS at the same time is under extreme winter pressure. Um I mean what responsibility do resident doctors have not to strike at a moment like this? So, I think in terms of the timing of it, the way that trade unions have to operate under the current anti-trade union laws, although I would note that it's just been it's obviously the employment rights bill has just passed, so this is changing. What I would say is we have to operate within six month periods. So, if we have an issue that members feel strongly about and we ask to ballot them, we ballot them and then if that ballot is successful, we then get a finite six-month window. Our six-month window expires on the 6th of January. When I took over in this role, which was essentially late September, I said, "Can we um please meet the health secretary? Can we talk? Can we get around the table? And can we get a deal done that fixes this absurd jobs crisis

4:00 for doctors in the UK?" and also addresses the real terms pay erosion that doctors have faced for the last 15 years in the face of more recommended real terms pay cuts that the government are pushing forwards at the moment. So that's what I said with no strikes on the table despite that it took industrial action in November to get the government to come forward and negotiate with us. On the day that that ended, hours afterwards, I wrote to the health secretary and extended uh my hand and said, "Can we please come to the table?

4:35 There are no strikes planned. There are no dates currently in the diary for further strike action. Can we get around the table?" That letter was not responded to.

4:45 We then announced industrial action and only after that did we then start to get things like offers. So that is why we have to take strike action which is regrettable to even get the health secretary to come to the table to fix this ridiculous jobs crisis and also to address the real terms pay cuts that he's pushing on to doctors which I don't think are acceptable. So in terms of the timing, our mandate expires on the 6th of January. The peak of the flu season and the busiest period for the NHS is usually January and what we've seen is just an earlier flu season this year.

5:20 We've got experts like Jonathan Vanam out there this morning essentially saying that we need to stop the well I I called it scaremongering at the weekend ask you about that

5:29 and to to dial down the rhetoric because actually urgent and emergency care is still being delivered by our consultant colleagues and this is the timing of it is being dictated by the government because of these last minute offers reluctance to negotiate and we are where we are because we feel like we genuinely have no choice if the health secretary won't even reply to a letter to take industrial action to announce it to bring him to the table. So that is why we were forced to take action during this period and that's why it couldn't be left to another period.

5:59 Yeah. Thanks. So I just want to go return to that point about perhaps pressures of being slightly oversold by the government. We've we've heard warnings from the government and NHS England that um of unprecedented waves of super flu. Um so and it's a this this creates a worst case scenario when combining it with residents doctors striking

6:21 uh is that an accurate picture or or do you think that pressures are being oversold?

6:27 So this I think to unpack this in two different ways. The first one we'll talk about the acute what's going on right now. Yeah. So flu is serious. Flu is always serious. Covid RSV other respiratory viruses equally serious. And I would encourage anybody who is eligible to get their vaccine to go out and get their vaccine as soon as they can, if not today. What we are seeing is language out of NHS England this morning to say, "Oh, actually the flu crisis has started to tail off despite what we've been seeing at the weekend." What we've seen is we there are roughly just over 3,000 patients in hospital with flu at the moment. At the peak of the last flu season, there was about 6,000. So, what we are seeing is the numbers aren't matching the rhetoric that's coming out of the politicians. And that is real scaremongering. And I think it's genuinely regressible that we're in this position where we feel like we have to

7:23 go and have these arguments in public rather than going back to what I want to do, which is get around the table and negotiate. M

7:28 and I guess the second thing which is a bit more of a chronic thing talk about crisis and you know um pressures and all the rest of it. Every single day of the year patients come to harm in our health care system because we can't deliver the patient care that we want to. Even in the middle of the summer our assessment unit where I work was full and we were seeing patients in corridors even in the middle of summer. That is because systems are failing. We do not have enough staff to be able to treat these patients to create the flow through the hospitals to get people turned around in a to get people through the hospitals to get people discharged at the other end.

8:06 We're working in a really inefficient system where doctors oft doctors often don't have an office. They've got to sit on bins in corridors to do their work. That is clearly a system that is not failing just in the winter, but is failing all year round. And what we're saying is let's get more qualified health care staff which are out there and willing to work into these jobs through the system to be able to not only get the waiting lists down but also to get patients through ANA departments to get more surgery done and a whole range of other things.

8:34 Can I ask you about delayed discharge as well because that's another issue that's cropped up in in regards to the timing of these strikes. Um and government officials have claimed the strike will leave p uh patients stuck in hospital beds unable to go home for Christmas. um especially older and frail patients. Um do you think that's correct? Is do you think this is a problem that could have been solved before?

8:56 So I think um if a patient is medically fit for discharge and is clinically well when doctors return to work on Monday, I can assure you that people will be discharged in time for Christmas. I think even before that there are consultants and there are specialist colleagues often with well over a decade's worth of experience who is I'm very grateful for stepping down to cover us during industrial action for the next few days. They are perfectly capable and they're often the ones that make the discharge decisions anyway and patients therefore will be discharged from hospital. I think the implication is that we're going to just not discharge patients for the next few days and then suddenly everyone's going to be in until Christmas. And I can tell you now when during this episode of winter pressures, we aren't going to keep people in hospital for an extra 10 days just because a few people have gone out on

9:43 strike for a few days essentially. We will be moving patients out if we can to get them home for Christmas.

9:50 Okay. We talked about the pressures then, but is there a level of pressure which you wouldn't strike? Is is that where's the line? So patient safety is a is a genuine key priority for not just me but the BMA. We are ultimately a member organization and we are all working doctors. You can't be a BMA official and not be a working doctor. across the next few days and even last night and today our team we call them the dergations team will be considering requests from NHS England whereby if the pressure is such that they genuinely feel that we need residents to come back to work and stop the strike in a particular focused area we will do so we will not put patient lives at risk what we've seen is the Nottingham obstetrics unit which is facing a huge amount of pressure there are police investigations going on there um they've been regularly criticized by several regulators. They are in a really really bad place.

10:47 However, what we do see is there are simply not enough consultant doctors and specialists to step down to cover those rotors and therefore the dergations team met last night. They met with local reps and the decision was granted that actually we need a number a small number of resident doctors to step up to safely staff those shifts. We take patient safety very very seriously and the scaremongering that is going on which I think is political scaremongering just needs to be taken with a dose of reality because we do take patient safety very very seriously

11:21 and you aware of any dergation requests today and any been accepted today so I've been on a picket line all morning I've been on a picket line all morning so I haven't been doing any of the deriggations this morning but myself there's a there's a larger number of people who get involved to offer different perspectives is to make sure that um the information is accurate because often what we get from organizations is inaccurate information where they try and pull essentially pull the wool over people's eyes. Um and what we get is we cross reference that with a a number of sources and then a number of individuals decide whether or not to grant that deriggation. Um the only deriggation that has been granted thus far this set of industrial action is the Nottingham ones and that's for the reasons I explained earlier. Understood.

12:02 What do you say to doctors today who feel deeply uncomfortable about striking? So I I I I don't want to strike. I think the health secretary said you do want to strike and was very certain about that. I don't and I've told him I've told him personally. Um I say that all the time. I don't think anyone wants to take industrial action. But if we just take a step back, we've got I listened to a colleague from Newcastle, uh which is where I'm from earlier today. and she said, "I know now on the 17th of December that I don't have a job next August. I don't want to go to Australia.

12:39 I just want to get on with my career. I just want to become the specialist that I want to be. I will do the grind. I will do the 72-hour weeks. I will crack on. I'll do what I need to do, but I can't because there's no job for me to do that." that doctor is a is a is a doctor who's been trained in the UK, who's been funded by the taxpayer and now can't find the job and they know that on the 17th of December for August next year. That is why resident doctors feel like they have no choice but to take to the picket lines. It's not a case of we don't want to be at work. We don't want to care for patients. That's absolutely not true. What we want to do is we want to be able to pro progress in our career to deliver that patient care to the best of our ability. We can't do that if we a have a shortage of doctors which we have. We look at other OECD countries and we are an underdocreded nation. We have fewer hospital beds than

13:31 other comparator countries quite significantly. And yet we are artificially capping the number of doctors that we are deciding to train. We've got bottlenecks all over the place. This is the acute one. But you know I know how difficult it is to get a GP appointment on a morning. I I am a patient. I I I ring my GP every now and again and try to get one and you sit listen to the hold music. And it's odd because as the person who then knows that we turned away four fully qualified doctors who want to be GPS, that is absolutely absurd and it needs fixing.

14:05 But not only are we turning doctors away at the front door, we're also losing doctors to other countries because they a feel like they don't have a choice because they don't have a job. But B, they come to a certain point in their training and think actually, you know, if I go to Ireland, if I go to Australia, if I go somewhere else, um they will essentially pay me more and also treat me better. And that's why doctors are leaving. They're looking and thinking actually I'm not worth a fifth less than I was back in 2008. I'm providing way more complex patient care.

14:36 I was looking after a patient recently who'd had a um major abdominal surgery which just wouldn't be possible sort of 20 years ago. And uh yet these doctors are looking at this and thinking actually the government is paying me essentially a fifth less in real terms than those doctors in 2008. But I'm doing more work. I'm seeing more complex patients and on top of that I am looking at else I'm looking at other countries and thinking well actually I could go to another country and even do the same level of work but be paid significantly more for it and that's why I was saying pay is a big part of this because we just we need to stop turning doctors away at the front door but we also need to try and start valuing doctors who are currently here to stop them from leaving at the same time

15:14 and I want to get back to pay but before that I just want to ask you about solidarity within the profession u and and how you would characterize it at the moment and you not just amongst resident doctors but about the whole of your membership bodies.

15:27 So I think if you look at the what why did we go into medicine? We went into medicine to practice the specialty that we want to do. We went into medicine if you wanted to be a surgeon to do surgery. I think there is a huge amount of frustration with the consultants that I speak to, the um specialist colleagues that I speak to that they feel constantly ground down in a system that does not work and does not value them and is essentially deprofessionalizing what they do.

15:58 But what about the support for this particular dispute? I was just about to come on to that. I think we couldn't do what we do in terms of a full strike without the support of our colleagues. And I think it goes back to why did we come in to medicine in the first place? Why did I sign up to be a doctor when I was essentially 16 to choose the A levels to then go on to university and all the rest of it.

16:21 And it's the same reasons as those consultants. Now, those consultants trained in a in a different system. Um, they could get the jobs progression. There were issues along the way and I'm not denying that. However, we couldn't do what we could do now and and sort of walk out of all care without our consultant colleagues stepping down. And I'm personally and I know colleagues on the picket line in London, colleagues on the picket line in Newcastle are incredibly grateful for them doing that. Yes, there are some consultants who feel actually we can do this in other ways. I think as the people who are in the negotiating room again I would say I would not be calling industrial action if I didn't genuinely think it was a last resort and we've tried and explored all other avenues. I am incredibly grateful for those colleagues covering us. Those colleagues there are some colleagues who disagree with us.

17:11 You're concerned about this support ebbing away that I mean we're on our third wave of strikes this year.

17:15 So so even amongst residents there are people there are there are people who don't agree with with what we're doing. There are people who are not members of the BMA. There are people who voted yes in the vote over the weekend. There are people who would have voted no in the last ballot. What we do see is an overwhelming majority of residents who support this action. From a consultant's point of view, um I certainly locally I had a text from my my clinical director yesterday saying our team are fully fully behind you. So I totally appreciate it's Christmas. There's uh sort of the the timing things we were talking about before. We wouldn't be doing this if we didn't think we had to to train the consultants of the future to get people into jobs to progress to become their colleagues in the future.

17:58 And that's why we feel like we have to do this because we have no other choice.

18:01 You're saying stick with us. Okay. I want to talk to you about training places because this this seems to be be becoming quite quite central to this dispute now. Um you know we know there are 40,000 doctors chasing about 10,000 training places currently. Um I mean how central is this jobs bottleneck to this dispute?

18:20 So it is uh one of the two reasons where we have disputes with the government. So um we can't fix um the trading crisis without also addressing pay erosion. That's because of what I was talking about before. We are not only turning doctors away at the door and saying actually we don't have jobs for you or we might have the occasional insecure contract over here which is six months long that we're not going to renew which is what happens if you don't get a training place. You either go on to bank work essentially um or you fall into one of these insecure contracts which are some of the most egregious employment contracts in the health service. uh we don't employ nurses or physiootherapists or anyone else on sort of 3 to six month contracts but yet for doctors it's seemingly acceptable.

19:06 Um or you do bank work or you you go abroad essentially. So it's a it is it is one of the it's one of the two central things as part of this dispute and we do need to fix that. But not only do we need to stop turning people away at the front door, we need to get um we need to stop people leaving if they're already in training because they see Ireland, Australia, other countries as way more attractive because actually they're getting paid significantly more and also they're being treated much better at work.

19:38 But hang on, didn't the government offer a major expansion of training places? And I'm just wondering why that wasn't enough. And just to recap, uh, in the the most recent offer, um, the health secretary, West Street, offered emergency legislation to prioritize UK graduates in the new year, 4,000 extra training posts over three years and an earlier starts for some of them. So, what was missing from your point your your your committee's point of view?

20:04 Uh, so it wasn't actually the committee. it was uh 30,000 members or roughly just under 30,000 members said that there wasn't enough in there to fix the jobs crisis or deliver an offer on pay and that offer was to settle both disputes on jobs and pay. In terms of the things that were missing, there's a there's a number of things in there for a trade union to take action and then by the next round of action have emergency legislation potentially going through parliament. That is a that is a big deal I think. Um, however, it was lacking a huge amount of detail. So, there are we have no idea how these how these posts will be prioritized. We've got no idea by what metric. Um, we have a huge number of international colleagues in the NHS who I've got no idea what the protections are for those doctors despite us advocating for them.

20:54 And this is because these the I think just to just just to to clar to get down into further detail. So a thousand places will be created for next the next training round and that will come from current locally employed doctor's jobs.

21:08 Yeah. So the just on on the legislation for a second, there's a huge amount of detail missing from the legislation itself. So that's the first reason why members have essentially rejected this. The second reason is because it simply does not go far enough. Even with every UK graduate and with others who have significant NHS experience, there will still not be a job available for them. And it's all well and good talking about competition ratios reducing and all and a whole range of other things. But you know what we're talking about here is patients being managed in corridors.

21:42 We're talking about patients not being able to see their GPS. We shouldn't be saying actually what we what we're going to do is get down to a competition ratio by doing a few sort of tinkering around the edges reducing the competition ratio from 4:1 to 2:1 for these specialty training jobs which is essentially what the legislation would do along with a few of the other things that would still leave 10,000 fully qualified doctors without a job. That clearly doesn't touch the size. And I think just to unpack the offer a little bit more, we've got the legislation without detail, without adequate protections for international colleagues and that is for locally employed jobs. So the legislation is just focused on specialty training places. However, what we would be doing is repurposing those locally employed jobs to turn them into training places.

22:31 There'll be no more doctors at the end of this. It's just a repurposed role. They are what we gather to be temporary,

22:38 but they will be doctors in specialist training, which is better than languishing on a locally employed doctor's job, which

22:43 they will. Yeah. Which which is why we said it is a step forward. But that so it's 4,000 jobs over three years. It's a thousand this year when we've got 40,000 doctors applying. And even with prioritization, 20,000 doctors applying for 11,000 jobs. still a ridiculous competition ratio when we know what we know about the failings of the NHS currently. But on top of that, once those thousand have gone through, there is no guarantee that they're going to stay. So actually what we're talking about is a thousand repurposed one-off jobs this year, 1,500 necessarily repurposed. Yeah. 1,500 repurposed one-off jobs next year and then 1500 repurposed one-off jobs next year with zero expansion of the medical workforce whatsoever.

23:32 So what figure would have worked for you then in this negotiation? So I think it depends on a number of things. It depends on the form of UK graduate prioritization because that obviously depends that talks that we then look at the number of applicants that are applying and then we can work out what that competition ratio looks like. We need to protect international colleagues who are currently working in the NHS. I work with a couple of colleagues who were internationally qualified who came over during CO who now have well approaching six years worth of NHS experience.

24:05 They have Britishborn children. We clearly need to protect those doctors because not only do they have the experience, but they're also now settled here essentially. We need to we need to protect those doctors and arguably prioritize them. However, we need to protect those doctors whose jobs are essentially going to be taken away from them to create specialty training places. We don't need a reshuffle. What we need is more doctors. So, you ask for a specific number. It depends on the other things and how the prioritization works. We're asking for employment sort of guarantees for periods for anyone going through this transitionary period because the NHS can't afford suddenly to start losing doctors just because of rep prioritized roles. We don't think that works and I think that's why this offer did not go far enough to fix the jobs crisis.

24:51 Thank you. And let's just turn to pay finally. Um what are you actually asking for now? Um uh I mean Wes Streeting said before the election that he would deal with junior doctor pay. Um is he in your view he's not delivering what he promised clearly?

25:06 No, he's absolutely not. Uh I think um so the BMA has uh stood up and said doctors across this country have faced real terms pay erosion for sort of best part of 15 years. So that's the starting point. We then had a period of doubledigit inflation which the offer from the government covered that period. So in real terms essentially worked out as about a roughly two 3% of two two to 3% real terms pay rise over that sort of short period. It does not address the previous 15 years and there are doctors who I know who are practicing right now who were doctors in 2008 as resident doctors. Um and where's streeting when he came in said pay restoration is a journey not an event. I wholeheartedly agree. What we have then seen from this government and the health secretary is a recommendation not not even just a sort of uh well you know we could do this a recommendation across not just residents consultants

26:09 the whole resident the whole doctor workforce a 2% essentially a 2% real terms pay cut by inflation figures from from last week. They are real terms pay cuts that are coming back into the government's line of sight. That is clearly not acceptable. So the offer was the offer. We accepted the offer because it was don't think anyone's disputing it was a good start to reversing that pay erosion. However, what we now need is a continuation of that. Um we need a continuation of that journey. that it does not mean more real-time terms pay cuts which this government has yet again recommended for doctors. So in terms of the ask it always has been and will continue to be to restore our pay back to 2008 levels. How we do that is entirely up for negotiation. You've got Wales who sort of today literally have just announced that they have reformed their contract. Coming with that is essentially a 4% additional investment

27:10 in the resident doctor workforce. We could be talking about contractual reform. We've got huge gender pay gaps in medicine at the moment because of the way our pay structure works. If you choose to take some time out and start a family, it's often around the time that your pay goes up to the next nal point, in which case you get trapped at that lower level.

27:29 Um, we could do stuff like that. We could we could um essentially get um we could start looking at paying doctors appropriate rates for the overtime which is compulsory that they do. So resident doctors work somewhere between 40 and 48 hours a week on average sometimes up to 72 hours in a single week. Those 40 to 48 hours I don't know another industry that routinely pays its staff playing time rates for enforced overtime. We could be looking at sort of enhancing that to basically um to pay doctors in that way. Or we could be looking at what we've always asked for, which is a multi-year deal, which protects against inflation and also moves well towards pay restoration. And in pounds and pence, we're looking at a firstear doctor, an F1 doctor, that could be as little as£1 extra in today's money each year for the next few years. that would see this dispute ended for a number of years and it would see our payer

28:33 restored. Is there a specific pay uplift like a number or percentage that would be sufficient?

28:40 Um, so we are looking for the restoration of our lost value. So I don't think anyone's asking for a double- digit number overnight. However, if that then goes over a number of years, which is what we're asking for, it must account for inflation. Because if I say let's just say and this is entirely hypothetical we want a 26% pay rise now which the governing the government are pedalling that's not true next year if inflation is is high then that number will change if inflation is low if we go into shrinkflation then that number will change so I can't give you a number because it entirely depends on inflation what I want is a deal that is over a number of years that makes sure that there's no real terms pay erosion and that does restore our pay. That's that's what we're looking to do and I'm very happy to sit down with the government and talk about how we do that. There are lots of ways we can negotiate that. Very

29:34 happy to sit down, very happy to talk about it, but I can't give you a specific number because we're not asking for anything overnight and therefore inflation must be accounted for and that's what we're asking for over a number of years.

29:47 Striking is expensive for doctors. So why five days at a time? um couldn't 2 days make the same point that 5 days does?

29:57 So there are a whole range of things we consider when we when we look at dates, look at length, look at type of industrial action. Um we consider the amount of time that doctors spend out of training during that industrial action. We consider international colleagues and the implications or the potential implications on their visas. we consider um F1 doctors particularly because they have a it comes back to the time out of training stuff where they've got a finite amount of time that they can have out of training on strike days or illness or anything else really. Um but there's a huge number of things that comes into it and um frankly that is genuinely wasted energy because that energy could better be spent getting around the table and getting a deal done. I'd far rather be spending my time and energy sat opposite the secretary of state or his team hashing out a deal to see an end to industrial

30:54 action than trying to think about when we're going to plan our next strike. But sadly, as we've sort of previously discussed, strikes seem to be the only thing that bring the health secretary to the table. This round of industrial action was um essentially 5 days. We considered a whole range of options. I think it would be we did not want we we were bearing patience in mind and we did not want to strike right up until Christmas. We've got consultant colleagues that we were considering. We've got F1 colleagues like I've talked about, international colleagues, a whole range of other stuff. We were thinking about uh the we were actually genuinely thinking about hospital pressures potentially in January and a whole range of other things which is why we sort of settled on the date that we did and that's that's pretty much it. There's a there's a whole range of planning outside of that as well that goes into

31:39 that to make sure that we've got the appropriate people around to do the derrigations work, make sure patient safety. There's a whole range of planning that goes into it. It's not just a random five string of five days. Um, but what I would say again is I'd rather spend that energy sat opposite the secretary of state getting a deal done than trying to plan more and more and more industrial action. I mean, we're sat here in BMA House and the BMA is currently being accused of hypocrisy over staff pay because its own staff has entered into dispute um with with the organization over below inflation pay and and they also want to see the end of pay erosion and what's your response to that?

32:18 So, you know, I um I have absolutely nothing to do with pay negotiations in the BMA. I'm here to represent my colleagues. because I'm an elected representative of resident doctors and I've got absolutely nothing to do with the pay for pay.

32:29 Do the optics concern you? Well, I mean I've I've got nothing to do with the I'm not involved in negotiations. Um I saw the news that came out at the same time as everyone else in the same way that I'm not here to talk about the fire service pay. I'm not here to talk about teachers pay. I'm not here to talk about BMA staff pay because I've got no say whatsoever in those decisions. And that's yeah, I'm here to represent resident doctors and my resident doctor colleagues.

32:56 Okay. If this strike fails to move the government, um what's your plan B? So I think we just have to look at the strength of feeling in our vote that happened in the last sorry and happened over 72 hours across the weekend. So we held a vote. The government gave us an offer. Um they asked us to extend sorry they asked us to put that offer to members and in exchange they would extend our industrial action mandate beyond the 6th of January. That was the reason they asked us to put that offer to members. Um we said we can do that anyway. We we don't need an extension to our strike mandate. We can keep the strikes as is and we can do that anyway.

33:38 So, we put it to members and what we had was an overwhelming response across the weekend. You know, if that was an industrial action ballot, we'd have absolutely smashed that out of the park in terms of getting a mandate to go forward. It wasn't. It was a vote on the offer. 83% of resident doctors said they reject the offer. Um, that was on 65% turnout, which is pretty impressive. Um, so I think our members have told us what the next step is. the strength of that turnout. Are you hopeful that you might, if necessary, get a new band, a renewable [clears throat] mandate?

34:15 So, on the back of that, we are currently rebaloting for um we're currently rebalotting to continue our strike mandate into for for 6 months essentially from from January. And I think um based on the strength of feeling of that result, we will never count our chickens. And there is a huge amount of campaign work for us to do to get out there and tell members that their action has moved the government in a number of ways. But it's not enough to fix this jobs crisis. And whilst I absolutely want to get around the negotiating table, get a deal done that fixes both issues, we will not stand to be ignored or also to continue real times pay erosion or to continue this jobs crisis for doctors. And if that means more industrial action, then that is what we will do. I do not want to be there. But if that's what we need to do, we will be out there campaigning and we will ask our members, is this enough,

35:09 look at the look at the look at the offer, look at the facts, look at the rhetoric, look at how things have gone, do you think we need to take more industrial action? If members vote yes, then what we will do is we'll get back around the table, try and avoid action, but but more action may be required if this government does not move.

35:27 Okay. Thank you.

Questions about this episode

Who speaks in "Resident doctor strikes during a flu crisis"?

Jack Fletcher (Host).

What is "Resident doctor strikes during a flu crisis" about?

The discussion revolves around the ongoing strikes by resident doctors in the UK amidst a flu crisis, highlighting their concerns over job security, real-term pay erosion, and the urgent need for government negotiations. Despite facing criticism from political leaders, doctors argue that their industrial action is a necessary response to unresolved issues affecting their profession and patient…

What is mentioned in this The BMJ episode?

6 people, works and ideas are mentioned, including Jack Fletcher, BMA, West Streeting, NHS England, BMJ, Jonathan Van-Tam. Each one on this page links to its own page with every episode that mentions it.

How long is "Resident doctor strikes during a flu crisis"?

The episode runs 36 min; the transcript is about 6,713 words in 67 timestamped sections.

More from The BMJ

• All analyzed episodes
• Books mentioned on The BMJ
• People mentioned on The BMJ
• Topics mentioned on The BMJ