Resident Doctors’ Strike Before Christmas: Pay, Politics, and Patient Safety

Disclaimer

This blog post is written in a personal and professional capacity. The views expressed are my own and do not represent those of my employer, the NHS, or any professional body.

The content is based on publicly available information at the time of writing and is intended to contribute constructively to informed discussion on workforce policy, industrial relations, and patient safety. No patient-identifiable information is included.

The post complies with the Nursing and Midwifery Council (NMC) Code (2018) and NMC guidance on the responsible use of social media, including the principles of professionalism, accuracy, proportionality, and public trust.

Shall we?

The British Medical Association (BMA) has confirmed that resident doctors in England will undertake a five-day period of industrial action from 17–22 December 2025, following the rejection of a late government proposal intended to avert the strike (BMA, 2025a). The timing—immediately before Christmas—has inevitably intensified political scrutiny, media attention, and public anxiety. However, focusing narrowly on timing risks obscuring the deeper structural issues that have driven this dispute over several years.

The Government’s Latest Offer

In early December 2025, following behind-the-scenes negotiations, the Labour government presented what it described as an eleventh-hour proposal to avert industrial action. Notably, the offer did not include any new pay uplift for resident doctors. Instead, it focused on structural workforce and training reforms framed as long-term solutions to morale, retention, and career progression issues (Department of Health and Social Care (DHSC), 2025a).

The key components of the offer included legislative reform to prioritise UK medical graduates and doctors with NHS experience for specialty training posts, addressing concerns about competition ratios and recruitment fairness (DHSC, 2025a). The government also committed to expanding specialty training numbers to 4,000 additional posts over three years, with 1,000 posts brought forward to 2026. Further measures included central funding for mandatory Royal College examination and membership fees and an increase in less-than-full-time training allowances, acknowledging the growing demand for flexible working among resident doctors (DHSC, 2025b).

While these measures represented meaningful workforce reform in principle, they were explicitly positioned as an alternative to further pay negotiations rather than a complement to them.

Why the BMA Rejected the Offer

Following a membership ballot, 83% of resident doctors voted to reject the proposal, a result that underscores the depth of dissatisfaction within the profession (BMA, 2025b).

At the core of the rejection lies real-terms pay erosion. Although resident doctors have received cumulative pay increases of approximately 29% over recent years, the BMA maintains that pay remains substantially below 2008–09 levels when adjusted for inflation (BMA, 2025c). From the union’s perspective, the government’s offer failed to address the immediate economic realities faced by doctors who are working longer hours in an increasingly pressured system while experiencing declining purchasing power.

The BMA also raised concerns that the proposed expansion in training posts may represent reallocation rather than genuine workforce growth, with limited impact on frontline staffing pressures if consultant capacity, supervision, and service infrastructure are not expanded in parallel (BMA, 2025b). Moreover, many resident doctors viewed the offer as aspirational rather than immediate, addressing future workforce configuration while leaving present-day cost-of-living pressures unresolved (Health Foundation, 2024).

Why the Government Will Not Offer More

The government’s reluctance to make further concessions on pay must be understood within a broader fiscal and political context. Public sector pay settlements are inherently interconnected, and a significant pay increase for resident doctors risks setting a precedent across other NHS staff groups, many of whom are also experiencing real-terms pay erosion (Institute for Fiscal Studies (IFS), 2024).

In addition, the government has framed workforce reform—rather than pay restoration—as a more sustainable response to long-term retention and productivity challenges. Training expansion and recruitment reform are less immediately inflationary than salary uplifts and therefore more compatible with current fiscal constraints (DHSC, 2025a). Politically, conceding under pressure during a period of winter service strain carries reputational risks, particularly given heightened media attention and public concern (The Guardian, 2025).

Media Narratives, Flu, and Patient Safety

Media coverage of the strike has frequently suggested that industrial action will place patients at unacceptable risk, particularly against the backdrop of rising influenza admissions. While it is true that England is experiencing a significant early flu season, this narrative risks oversimplification.

NHS England has confirmed that formal contingency plans are in place to maintain emergency and urgent services throughout the strike period (NHS England, 2025). Evidence from previous industrial action indicates that patient harm is more closely associated with chronic understaffing, bed shortages, and system congestion than with short, planned periods of industrial action (Moberly, 2023).

The BMA has therefore challenged what it describes as alarmist and misleading reporting, arguing that conflating winter pressures with industrial action undermines informed public debate and erodes trust (BMA, 2025b).

From a professional standpoint, discussing patient safety in an accurate, proportionate, and evidence-based manner aligns with obligations under the NMC Code to preserve public trust and avoid sensationalism (NMC, 2018).

My Position: Support, Solidarity, and a Necessary Question

It is important to state clearly that I support the principle of industrial action by resident doctors. Their concerns regarding pay erosion, training bottlenecks, and long-term workforce sustainability are well-evidenced and, in many respects, reflect challenges faced across the wider NHS workforce.

Support, however, does not preclude reflection. After more than two years of sustained dispute between the BMA and the government, an uncomfortable but necessary question arises: where does this lead?

Prolonged industrial conflict carries cumulative costs—not only financial and operational, but relational. Trust between workforce and government has eroded, and fatigue is evident on all sides. There is a risk that the dispute becomes structural rather than negotiable, characterised by entrenched positions rather than meaningful progress. Training reform without pay resolution, or pay offers without long-term workforce planning, will continue to fall short.

This reflection is not a withdrawal of solidarity. Rather, it is an acknowledgment that industrial action is a means, not an endpoint. Without a credible pathway to resolution, there is a danger that repeated cycles of strike action become normalised, to the detriment of morale and sustainability across the health system.

What This Means for Those Still Working

For clinicians continuing to work during the strike period—including myself—this translates into covering our own specialties while supporting on-call and acute services, managing redistributed workloads, and maintaining clear, calm communication with patients amid heightened media noise.

From an NMC perspective, this approach aligns with professional duties to prioritise people, practise effectively, preserve safety, and promote professionalism and trust (NMC, 2018). Continuing to work during industrial action is not an act of opposition but one of system stewardship, ensuring continuity of essential care while recognising the legitimacy of colleagues’ grievances.

Conclusion

The December 2025 resident doctors’ strike is not a failure of professionalism but a manifestation of long-standing structural pressures within the NHS. The government’s latest offer addressed elements of workforce reform but failed to engage meaningfully with pay erosion, leading to its decisive rejection.

Media narratives that foreground risk without context obscure the reality that patient safety is most compromised by chronic workforce shortages and systemic underinvestment, not by carefully managed industrial action. Supporting strike action while questioning its long-term trajectory are not mutually exclusive positions. Both are necessary if the NHS is to move beyond cyclical dispute toward a sustainable future for its workforce.

References

British Medical Association (BMA) (2025a) Resident doctors in England to strike from 17–22 December 2025. London: BMA.

British Medical Association (BMA) (2025b) Resident doctors vote to reject government offer. London: BMA.

British Medical Association (BMA) (2025c) Pay restoration for resident doctors in England. London: BMA.

Department of Health and Social Care (DHSC) (2025a) Government proposal on specialty training reform. London: DHSC.

Department of Health and Social Care (DHSC) (2025b) Supporting resident doctors: fees, flexibility and training. London: DHSC.

Health Foundation (2024) NHS workforce pressures and pay trends. London: The Health Foundation.

Institute for Fiscal Studies (IFS) (2024) Public sector pay and fiscal constraints. London: IFS.

Moberly, T. (2023) ‘Doctors’ strikes and patient safety: what does the evidence show?’, BMJ, 382, p. 1912.

NHS England (2025) Operational guidance: industrial action by resident doctors. London: NHS England.

Nursing and Midwifery Council (NMC) (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC.

Nursing and Midwifery Council (NMC) (2023) Using social media responsibly. London: NMC.

The Guardian (2025) ‘Doctors’ strike threatens Christmas NHS services, ministers warn’, The Guardian, December.