It’s conference party season, with a general election on the horizon. The ruling Conservative Party has been in Manchester this week, having been far behind in the polls for months. And the future of the NHS consistently ranks among the touchstone issues likely to define the next election.

As health secretary Steve Barclay was giving a speech on Tuesday afternoon, thousands of doctors gathered moments from the conference centre to demand pay restoration. They had travelled from all corners of England on buses provided by the BMA.

Prime minister Rishi Sunak decided on the slogan ‘long-term decisions for a brighter future’ for his conference. It was widely mocked by doctors at the pay restoration rally, who for decades have seen a Conservative Government attempt no more than short-term fixes to the health service they see crumbling around them every day.

Central to restoring the long-term future of the NHS is incentivising doctors to work in the system. Doctors say the only way to do that is to pay competitive rates in what is a global market.

BMA council chair Phil Banfield gave the headline speech at a lively Manchester rally and vowed that the union is ready to continue striking until the next general election, when it comes, ‘if that’s what it takes’.

‘But our patients need the prime minister to meet with us now; restore the value of pay, now; make a credible offer, now; end these disputes, now,’ he told the crowd. This is: ‘For our future, for our patients, and the future and health of the people of this country.’

Junior doctors have been striking since March, and consultants since July. Prof Banfield praised BMA members for being ‘unflinching in the face of a Government scandalously trying to scapegoat doctors for 13 years of their failures’.

Vivek Trivedi, co-chair of the BMA junior doctors committee reflected this sentiment in his speech, reiterating that – until a credible offer is made – doctors ‘are not going anywhere’ because ‘we deserve fair pay’.

‘The Government is fighting for its survival, and we have the public on our side.’

Members of the public also blame the Government for record waiting lists, according to the results of a September survey of 1,765 adults in England, released this week.

Doctors’ defiance is despite the Government digging in on its ‘final’ pay offer of a 6 per cent uplift for consultants, and 6 per cent plus a lump sum of £1,250 for junior doctors in England. Health secretary Steve Barclay has not met with the BMA’s negotiating committees for months.

Barclay used his conference speech to lay out plans to update the NHS constitution, to ban trans patients from being seen in female-only or male-only wards – and announced funding for technology. There was no mention of ending strike action.

Prof Banfield said the speech was ‘a distraction from serious NHS problems’, adding: ‘Mr Barclay claims to be focused on outcomes all while refusing to speak with those who deliver care.’

Consultants again wrote to Sunak on Monday, this time holding off announcing new strike dates for four weeks ‘in an attempt to reach a resolution’ with Government, which has said it will not enter negotiations while strike dates are called.

BMA consultants committee chair Vishal Sharma, who also addressed the Manchester rally, reiterated the BMA was willing to involve conciliatory body ACAS, stressing ‘there is now no possible reason why the Government cannot negotiate with us with a view to ending this dispute’.

BMA consultant committee deputy chair Mike Henley told the rally: ‘The Government may tell itself that avoiding compromise shows strength. But it is clear to the eight million voters awaiting care that this is no more than cruelty and abandonment.’

Doctors descended on Manchester from across England to attend the rally. The Doctor joined a group on a coach departing BMA House in London at 7am on Tuesday.

Consultant anaesthetist Rachel Freedman said the sheer number of doctors travelling to Manchester showed how serious the profession is about securing the future of the NHS.

‘This is not a minority of doctors, as Government spin might suggest,’ she said. ‘We are a large group of cohesive doctors who have said enough is enough.’

Dr Freedman noted the importance of reform of the Review Body on Doctors' and Dentists' Remuneration, which a Conservative backbencher has said is ‘basically rigged’. She insisted it must be fully independent to help restore trust among doctors who are leaving the NHS in increasing numbers.

As many consultants do, she also sees the strike as a battle for the future of the NHS as a free-at-the-point-of-care service.

‘It feels like the NHS is at real risk,’ said Dr Freedman. ‘I never thought I’d see that in my career. But it won’t be sustainable with continual under-funding and staff who aren’t remunerated properly.’

Amir Palermo, a UK-trained doctor from Malaysia, says he fears the UK’s healthcare system could fall into a ‘two-tier service’ comparable with that in his home country if the pay issue is not resolved.

Dr Palermo, a psychiatry trainee, said: ‘It is very clear that the Government is not negotiating in good faith. This is a political choice.’

He noted, however, how strike action had moved the dial, with the imposed uplift an improvement on the Government’s opening position, despite still being below inflation.

Having consultants join industrial action in recent weeks has created a greater sense of ‘camaraderie’, added Dr Palermo. ‘Knowing our bosses are in this with us is reassuring. It shows this is a fight worth fighting.’

Rachel Southern-Thomas, a foundation year 4, said that consultants going on strike, and moves towards ballots from doctors in devolved nations, has provided ‘extra solidarity’.

‘It feels like we’re getting somewhere,’ she added while noting the ‘grinding’ progress has not been as quick as many doctors would like.

Dr Southern-Thomas also criticised the ‘convenient amnesia’ of the Government when it comes to its change in attitude towards doctors when striking for fair pay compared with how they were treated at the peak of the pandemic.

The reality for many doctors, she said, is that the workload on the front line is still as intense as it was during COVID, if different in terms of priorities.

Foundation year 2 Robert Gittings agreed, saying: ‘It’s as if we’ve gone from heroes to enemies of the state. It’s really hypocritical.’

Dr Gittings explained how he and colleagues often work above and beyond their standard 48-hour weeks to keep patients safe, yet still have to battle through the exception reporting system for extra hours to be paid.

‘All we are asking for is fair pay,’ he said. ‘The rally will help us show the Government we are not losing momentum. They should know we are not going to go away.’

As the consultants and junior doctor disputes rumble on, more doctors are moving towards taking industrial action.

Staff, associate specialist and specialty doctors in England have opened an indicative ballot, which runs until 16 October. 

Meanwhile, consultants in Northern Ireland this week confirmed they will ballot for industrial action, after the devolved government – which essentially has no health minister owing to a stalemate over the Northern Ireland protocol resulting from the Brexit referendum – said it would not offer any pay uplift for doctors, despite DDRB recommendations.

Of the consultants polled in Northern Ireland, 77% said they were willing to take industrial action.

Junior doctors in Northern Ireland are also preparing to ballot. Respondents to a recent survey reported how workload pressures meant they are unable to continue with training, and that low pay meant they are now more likely to leave.

In Wales, junior doctors are to be balloted for industrial action from 6 November to 18 December. Consultants and SAS doctors in Wales will also be balloted. All groups of doctors were offered a pay uplift of 5 per cent, not just below inflation but below that offered to colleagues in England. 

It is only in Scotland where there has been any resolution. Junior doctors in Scotland accepted a 17.5 per cent pay uplift over two years, which included a ‘key’ commitment from the Scottish government to work towards full pay restoration in the future.

BMA Scotland, however, continues to warn that the devolved Government must take ‘real action’ to stem low morale among consultants who were handed the same 6 per cent offer as in England, and have not ruled out balloting for industrial action.