Disclaimer

The views expressed here are entirely my own and do not represent Somerset NHS Foundation Trust, the Upper GI team, or any rota coordinator who may or may not be desperately trying to fill tonight’s shifts. No patient details are included. No bleeps were harmed in the writing of this blog.

The latest round of industrial action by postgraduate doctors began yesterday morning, extending through to 07:00 on Wednesday. Unlike previous strike periods, I am not covering any medical gaps—no F1 shifts, no SHO cover, no rota firefighting. For several personal and professional reasons, I declined. This weekend, for the first time in a while, I am “only” covering my own specialty: Upper Gastrointestinal Surgery.

“Only,” of course, being NHS shorthand for still far too much, but technically my actual job description.

Keeping the Upper GI Service Running Amid Industrial Action

Yesterday, one of our Upper GI registrars and I handled the specialty workload while the other two registrars were assigned to elective theatres. Against all expectations (and all previous strike-day experience), both lists ran in full.

Meanwhile, several of our inpatients—complex, unwell, and thoroughly uninterested in national negotiations—required timely interventions from medical specialties. Fortunately, the majority received what they needed before the weekend began, allowing us to create detailed post-procedure plans, order essential bloods, and make sure no one fell between the cracks.

Once the weekend plans were finalised, I dashed off to collect our son from school, leaving my registrar to steer the ship through evening handover.

This weekend is finally mine. Monday will come soon enough—hopefully with fewer traffic incidents than Friday’s.

What This Strike Is Really About: Beyond the Pay Narrative

Public debate tends to reduce the strike to a single talking point:
“Doctors want more money.”

But academic, economic, and workforce analyses paint a far more complex—and far more troubling—picture (BMA, 2023; Nuffield Trust, 2023).

1. Pay Restoration vs. Government Offers

Postgraduate doctors have seen a 25–30% real-terms pay cut since 2008 (BMA, 2023). Government offers so far have amounted to below-inflation increases, typically in the single digits, with some targeted supplements but no structural reversal of pay erosion (DHSC, 2023).

The BMA’s argument:
Restoring pay to 2008 levels is essential simply to prevent the workforce from haemorrhaging further.

The government’s stance:
Full restoration is “unaffordable” and “inflationary,” though ironically agency spending continues to rise dramatically as vacancies worsen (National Audit Office, 2022).

2. Working Conditions: The Hidden Crisis

The strikes also shine a light on the daily reality faced by junior doctors:

• Unsafe rota patterns, frequently non-compliant with safeguards.
• High patient acuity, with fewer staff to manage increasing complexity.
• Escalation delays, not due to negligence but due to simple absence of available staff.
• Burnout, now an endemic feature of NHS workforce surveys.
• Emotional and moral injury, especially where doctors cannot provide the care they were trained to deliver.

Academic literature is increasingly clear: chronic understaffing is directly linked to lower patient safety, higher error rates, and increased mortality in acute care (Marmot et al., 2020; West et al., 2022).

3. Job Security and Career Progression

Junior doctors also face growing uncertainty about their long-term careers:

• Oversubscribed specialty training posts.
• Increasing competition ratios.
• Expansion of SAS and Trust-grade posts without equivalent training structures.
• Limited geographic flexibility.
• Concerns about stagnation and bottlenecks.

Government messaging emphasises increased medical school places, but workforce modelling shows that without proportional training capacity, supervision, and protected learning time, this simply pushes the bottleneck further downstream (NHS England, 2023).

A Wider Philosophical Divide

Ultimately, this dispute is not just about percentage points; it is about identity, value, and the vision for the NHS workforce.

• The government frames pay and conditions as primarily financial matters.
• Doctors frame them as patient safety issues and workforce survival issues.

The exodus to Australia, New Zealand, and Canada is not theoretical. It is quantifiable, worsening, and increasingly visible in day-to-day staffing patterns.

This is not entitlement.
This is a profession fighting to make its work sustainable.

Back to Monday (and Beyond)

For now, the strike continues through the weekend. Monday will arrive, and with it another day of trying to manage patient needs, workforce shortages, and the endless churn of NHS logistics.

Whether the government chooses to negotiate seriously after this round of action remains to be seen.

What is certain is that this dispute is far from over.

References

BMA (2023) Pay and Contract Restore: Junior Doctor Pay Erosion Analysis. London: British Medical Association.

Department of Health and Social Care (DHSC) (2023) Government Evidence to the DDRB 2023–24. London: DHSC.

Marmot, M., Allen, J. and Goldblatt, P. (2020) Build Back Fairer: The COVID-19 Marmot Review. London: Institute of Health Equity.

National Audit Office (2022) Managing NHS Backlogs and Waiting Times. London: HM Government.

NHS England (2023) Long Term Workforce Plan. Leeds: NHS England.

Nuffield Trust (2023) The State of the NHS Workforce in England: Shortages, Pressures and Trends. London: Nuffield Trust.

West, M., Bailey, S. and Williams, E. (2022) The Courage of Compassion: Supporting Nurses and Doctors in the NHS. London: The King’s Fund.