Resident Doctors: Industrial Action

Caroline Nokes Excerpts

Thursday 26th March 2026 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

With permission, Madam Deputy Speaker, I will make a statement on the proposed industrial action by resident doctors.

Yesterday evening, the British Medical Association called its latest round of strikes for 7 to 13 April, immediately following the long Easter bank holiday weekend. The announcement came just hours after its resident doctors committee rejected an historic deal that would have boosted pay, created jobs, improved career prospects and put money back in the pockets of its members. This was deeply disappointing after months of highly constructive and good-natured talks between the Government and the leadership of the RDC. In that context, the fact that the BMA’s immediate response was to call such extensive strike action, rather than return to the table, speaks volumes about what we are up against.

I will set out how we have reached this regrettable position. Since the start of this year, the Government have been holding extensive and intensive discussions with the BMA resident doctors committee leadership, who engaged in good faith. I have spoken personally to or met with the chair several times, and those engagements were, of course, on top of the near-daily dialogue that his team held with officials from my Department. 

Together, we got further than many thought possible. As a result of our discussions, a landmark deal was put formally to the full resident doctors committee on 22 March. Based on our engagement with the BMA officers, we were optimistic that it would be received positively, although I was aware of the officers’ preference that it should be a deal over two years rather than three years, and that they had expected the independent recommendation of the Review Body on Doctors’ and Dentists’ Remuneration—the DDRB—to come out slightly higher than it did. Regrettably, despite the deal having been designed with and supported by the BMA leadership, the committee itself rejected it yesterday.

I will run through what the RDC has unilaterally rejected on behalf of the 81,337 resident doctors in this country. The headlines of the deal are: reform of the pay structure, so resident doctors would benefit from more frequent pay rises at each stage of their training; pay rises over three years baked in, linked to the independent DDRB recommendations, as requested by the BMA; and reimbursement of Royal College exam fees from April this year, which resident doctors currently pay out of pocket. They can be as much as £2,200 for psychiatry, £2,300 for paediatrics and £3,700 for ophthalmology. Other headlines are: contract reform for locally employed doctors to ensure they also benefit from greater job security, equal opportunities for pay progression, and improved terms and conditions; and up to 4,500 more specialty training places created over the next three years, including 1,000 for this year’s applicants.

Alongside the deal, the Government have just passed the Medical Training (Prioritisation) Act 2026, so that domestically trained resident doctors no longer compete on equal terms with overseas graduates for specialist jobs. The Act will reduce the competition ratio for jobs from almost 4:1 to almost 2:1. The deal also follows the 28.9% pay rise already delivered by the Government.

As a result of the proposed package, resident doctors would have seen an average pay rise of 4.9% this year; starting pay for new graduates entering the profession this year would have been nearly £12,000 higher than four years ago; the lowest-paid foundation year ones and foundation year twos would have seen a pay boost of at least 6.2% and 7.1%, respectively, this year; and there would have been 1,000 more resident doctor jobs in a matter of days from this April.

Along with pay decisions that I have already taken, the package would have meant that, this year alone, resident doctors would have been, on average, 35.2% better off than four years ago. There are not many, if any, professions in our country for which that is true. The DDRB recommendation is 3.5%, which is significantly less than what is on offer as a result of pay structure reform.

The BMA has pointed to the war in Iran as reason to reject the deal. I will spell out the consequences of what this country is facing. The Government want to see de-escalation and a swift resolution to the conflict, with a negotiated agreement that puts tough conditions on Iran, specifically in relation to its nuclear ambitions. However, we are planning on the basis of a prolonged conflict, because that is the prudent thing to do. In that eventuality, there would be an impact on the economy and on the public finances. Were that to happen, a future offer to resident doctors would not look better than what is on offer today.

The Government’s tolerance for costly and disruptive action that undermines a critical public service is fast diminishing. In three years’ time, I do not want resident doctors to look back on this moment with regret as they turn down three years of guaranteed pay rises, more money in their pockets through reimbursement of exam fees, and more jobs. The BMA is choosing more strikes. As a direct result of its decision, and despite our best efforts, resident doctors will be worse off. Indeed, on the very day that 1,000 more specialty training places would have opened up for resident doctors with this deal, the BMA will be on strike, demanding more job opportunities.

Let me turn to the impact on patients and the NHS. Yesterday, the British social attitudes survey revealed that patient satisfaction has increased for the first time since before the covid pandemic. Dissatisfaction has seen the sharpest decline since 1998. Patient satisfaction with access to GPs has gone from 60% when this Government came to office to more than 75% today. Wating lists are the lowest they have been for three years, four-hour performance in A&E is the best for four years, and ambulances are arriving faster than they have for half a decade. All of this has been achieved despite the BMA’s strikes, so I want to reassure patients that the NHS’s recovery will continue.

In the most recent round of strikes, the NHS team pulled together and delivered 95% of planned elective activity. I am confident that we will see the same outstanding efforts if further action is taken. But to the BMA, I say: we can achieve so much more, and the improvements can be so much faster, if you take this deal and stop your strikes. Strikes have a significant financial cost. Every penny spent on keeping the show on the road during strikes is a penny that cannot be spent on improving staff pay and working conditions or better care for patients. The impact on the other staff working in the NHS, who are left to pick up the pieces, is severely felt.

So I am asking the BMA’s resident doctors committee to reconsider. I will meet again with its officers. I also repeat my offer to meet with the entire committee, who have thus far refused to meet me since I became Secretary of State. Indeed, they are the only group of people I have offered to meet who have declined, which I find extraordinary in these circumstances. The deal on the table shows what we can achieve when we work together. In contrast to my predecessors, I have shown good intent from the outset. I have listened to the complaints that resident doctors have about their working lives—I agree with them, and I want to work with them to improve their working conditions as we improve the NHS.

But when it comes to making a deal, the reality is that it takes two to tango. The BMA has until next Thursday to reconsider before we have to call time on the extra jobs, and the focus of the NHS and my Department turns to minimising the disruption from this unnecessary and unwarranted strike action, which would also consume the money set aside for this deal. But there will be a cost to the NHS, to staff and to patients. This was an historic opportunity, developed in tandem with the BMA leadership. I urge the committee to reconsider. I urge the BMA to call off its industrial action. I commend this statement to the House.

[Madam Deputy Speaker (Caroline Nokes)]

I call the shadow Secretary of State.

--- Later in debate ---

[Wes Streeting]

I thank my hon. Friend for his support in trying to influence a more constructive approach, for the advice that he has given me and members of the resident doctors committee, and for the experience that he brings to these exchanges. He is right to praise Jack Fletcher for the constructive approach that he and his officers have taken. It has not been easy, but I know that officials have enjoyed the constructive engagement, and I thank enormously the officials who have worked tirelessly on this. I think all those involved in the discussions, on both sides of the table, are disappointed by the outcome, and that is why I urge the BMA to seize the offer before it is too late.

My hon. Friend talks about other changes, such as to placements and rotations. I think that BMA officers recognise my desire to not only do this deal, but to create a new business as usual with the BMA, where we have people around the table on a regular basis looking at what we can do to improve the health service for patients and staff and to make real progress on those issues. We cannot do that if we are in conflict. That is the tragedy of the position we find ourselves in. I think we have built trust through engagement and dialogue with the BMA committee officers. It is only disappointing that members of the committee are not prepared to get around the same table as me, because if they did, they might realise the sincerity and the opportunity.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

People across the country will be extremely concerned about the prospect of further strikes, having faced so much disruption already in recent years. It is important to recognise that the strike is a symptom of an NHS still coming to terms with the damage caused by the previous Conservative Government. Doctors are burnt out from working in high-pressure environments under poor conditions—often trying to save lives on corridors with no space or privacy. However, we all know how difficult public finances are, and that is now being compounded by Donald Trump’s reckless war in the middle east. Therefore, a further 26% pay rise is not affordable or realistic at the moment, and it is time the BMA recognised that.

There is much more the Government could be doing to support both staff and patients. The BMA has a mandate to strike until August, yet patients struggle to get GP appointments and suffer months of pain while stuck on waiting lists. How will the Secretary of State stop the situation dragging on throughout the year and causing yet more harm to patients?

We must also show staff and patients that things will get better. Lib Dem plans to recruit and retain more GPs, offer one-to-one midwife care and fix the social care crisis would offer the NHS the hope that is needed by easing pressure on staff and patients. Will the Secretary of State consider fixing crumbling hospitals as a priority, to give staff and patients the working conditions and dignity that they need and deserve?

At Shropshire’s major hospitals, it is common to see ambulances queuing up outside, unable to offload their patients, while staff inside are struggling to cope with patients in corridors. Will the Secretary of State commit to ending the misery of corridor care by the end of this Parliament? I welcome his intention to build additional training places, but will he outline a timetable for publication of the workforce plan, because that is critical for the future of our NHS?

--- Later in debate ---

[Wes Streeting]

It is frankly breathtaking hypocrisy. It rather looks like doctors in their ivory tower saying one thing, and lecturing us about what is and is not affordable, but when it comes to how their subs are spent and how their own union behaves towards its own staff, not being prepared to pay them. I have been very complimentary about the officers who have been engaged with Ministers and my officials in recent weeks to try to get this deal over the line; so have BMA staff. I am stunned by the BMA’s unwillingness to practise what it preaches. I will not be joining resident doctors on the picket line. I should have declared, Madam Deputy Speaker, that I am GMB member, so if there is one picket line that I will be visiting during the doctors’ strikes, it may well be that one.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Chair of the Health and Social Care Committee.

[Layla Moran (Oxford West and Abingdon) (LD)]

This is clearly the wrong move again. It is really stark; we keep hearing from patients across the country about how much they want the NHS to improve, but this is another blow to them, and they may even wonder if it is safe to go into their local hospital during the strike period.

I am grateful to the Secretary of State for coming to the Committee and talking about corridor care. The really interesting thing about that session was that the hospitals that have turned things around did so because of leadership from the top. Their executives and board members were going into hospitals out of hours and on weekends to speak with resident doctors, nurses and patients, to see what things were like on the ground. When was the last time the Secretary of State did that? This is not a “gotcha” moment—I have not done that recently, but I want to. If we are to lead a change in culture in the NHS, we should all show how we would do it, and should urge board members and executives to do the same, in every hospital across the country.