Kirsty is a junior doctor. She’s 25 and right at the beginning of her career, but she doesn’t feel any excitement about her prospects in the NHS. Instead, when she thinks about the future of her working life, she’s filled with anxiety. “It’s not a secret that the NHS has not had the funding it needs for decades,” she tells me. “I’m sure anyone who has come to hospital recently will have experienced longer wait times, difficulty getting appointments, slower care. And if the government continues to not prioritise NHS workers, eventually, they won’t have the staff to run it at all.”

Kirsty is one of thousands of junior doctors who will be taking part in the six-day walkout between 7am on January 3 and 7am on January 9, the longest single strike in NHS history, in a major escalation of their long-running dispute with the UK government. This latest action follows a series of strikes in recent months, with the majority of British Medical Association (BMA) members consistently voting in favour of strike action.

The BMA’s members said they had taken the decision to strike because they feel “overworked and undervalued”. They’re demanding a new gradual pay increase of 35 per cent to make up for inflation in the past 15 years, which has cut junior doctors’ real terms earnings by 26 per cent. “Many people do not realise the reality of being a junior doctor. A new junior doctor starts at only £14 per hour,” Alex, a 29-year-old striking junior doctor says. He adds that junior doctors are also made to pay professional fees and exam fees, which can add up to thousands of pounds. Many doctors also face long, costly commutes to work, and those who drive in are made to pay for parking once they’re at the hospital. Additionally, student debt for a doctor can be up to £90,000 due to the sheer length of their studies. It’s easy to see how these hidden costs quickly add up.

The strike isn’t just about pay and the financial toll of pursuing a career as a doctor, though. Alex also mentions the stress of regularly moving workplaces and “difficulty in life planning more than a few months ahead”. The day-to-day work too is, obviously, intensely emotionally draining. Recent research from the University of Leeds found that many NHS junior doctors suffer panic attacks and experience intrusive thoughts, migraines and hair loss as a result of work-related stress. Separate research from the GMC found that there were an increasing number of medical trainees experiencing burnout, with one in five junior doctors at high risk of burnout in 2022, compared to one in seven in the previous year.

Kirsty explains that a ‘normal’ day at work for doctors can be incredibly difficult. “I’ve been verbally abused, I’ve had multiple people try and hit me, I’ve been bled on, thrown up on, I’ve given CPR to three patients in the space of a few hours... and then I’ve just had to continue helping the other 20 patients left on my list, like all the other doctors I know,” she says. She stresses that she doesn’t “resent” any of this – “I knew the job I was choosing and it’s the only one I’ve ever wanted to do,” she says. But she explains that she just wants the government to understand the challenges doctors face and treat them with the respect they deserve.

“When you cancel out inflation, I’m paid 26 per cent less than a doctor doing my job 15 years ago. Our pay has decreased and yet we work harder and harder to give patients the best care we can, despite all the NHS crumbling around us” – Kirsty

“Striking for fair pay is about being valued by the government for the job we do,” she says. “When you cancel out inflation, I’m paid 26 per cent less than a doctor doing my job 15 years ago. Our pay has decreased and yet we work harder and harder to give patients the best care we can, despite all the NHS crumbling around us.”

It’s self-perpetuating: the worse pay and conditions get, the fewer people train as doctors and the more doctors leave the profession, and the resulting staff shortage exacerbates conditions by placing more pressure on the remaining staff. Essentially, something needs to change, or the situation is only going to get worse: a survey published in December 2022 found that 79 per cent of junior doctors often “think about” leaving the NHS, while four in ten are actively planning to leave the profession as soon as they can find another job.

Some are even leaving the UK to work for better pay and conditions abroad. “Something that has been particularly hard is having several of my close colleagues and friends moving permanently to Australia for better working conditions and pay,” Alex says. “Every year I see a number of excellent colleagues emigrate to other countries including the USA, Canada and New Zealand.” Kirsty too adds that many of her colleagues have left for Australia. “You can’t blame people for wanting to leave a system that just doesn’t seem to care about them anymore,” she says.

Dr Vivek Trivedi and Dr Robert Laurenson, co-chairmen of the BMA junior doctor committee, said in a statement: “The government has dragged its feet at every opportunity. It has not presented any credible offer and is refusing to accept that there is any case for pay restoration, describing our central ask as ‘unrealistic’ and ‘unreasonable’ [...] they continued to add new unacceptable preconditions to talks instead of getting on and trying to find a resolution.”

“We therefore have no confidence that without further action these negotiations can be successful,” they continued. “This situation is entirely of the government’s own making. We want to spend our time looking after patients, not on strike. But with an NHS buckling under a workforce crisis, and four in ten junior doctors looking to leave, we can’t stand by while our pay is further eroded by inflation and an intransigent Government.”

A Department of Health and Social Care spokesperson said: “Further strikes will risk patient safety and cause further disruption [...] Our door remains open to constructive conversations, as we have had with other health unions, to find a realistic way forward which balances rewarding junior doctors for their hard work while being fair to the taxpayer.” (As Kirsty points out, there is no significant impact on patient mortality during strike periods, and patients will suffer in the long-term anyway if the government continues to underfund the NHS and underpay its staff).

The last time junior doctors went on strike was 2016, over a new contract proposed by Jeremy Hunt, Health Secretary at the time. The strike wasn’t hugely successful – but the context now is very different to 2016. Junior doctors aren’t alone – they’re joining a slew of other NHS employees who have also gone on strike in recent months in a bid to fight back against real-term pay cuts and patient safety, as well as a number of other workers – such as rail workers, teachers, and postal workers – who have also taken similar action in the past 12 months. More of the public support striking junior doctors this time around, too, with the majority of people supporting the junior doctor strikes. More broadly, there’s certainly an amplified sense of gratitude and respect for healthcare workers post-pandemic, and a real desire to see this appreciation translated into something more concrete than clapping on doorsteps. We’re yet to see what the result of the ongoing dispute will be, but it’s clear there is reason to be optimistic. And one thing is certain: things cannot continue as they are.

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