About the offer
What is the offer?
Pay:
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The pay offer is an additional average 4.05% for year 23/24 on top of the existing average 8.8% that was recommended by DDRB and implemented last year, taking the average uplift for 23/24 to 13.2%.
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This would be compounded by the agreed 24/25 DDRB recommendation of 6% and £1000 consolidated (average 8%), which would equate to doctors seeing an average 12.4% uplift this year against their current 23/24 payscales (as opposed to average 8% uplift if offer rejected).
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Over the two years, this would be a cumulative 22.3% uplift, of which 17.7% awarded by DDRB recommendations and the extra from the Government offer.
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The offer also includes indexing Flexible Pay Premia (FPP) payments to DDRB uplifts for basic pay to prevent erosion of those pay elements.
Non Pay:
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Changes to the exception reporting process to improve uptake and reduce stigma to use, by removing supervising consultants from the process, reducing many of the barriers doctors currently face when trying to reclaim time spent at work.
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Additional reviews in longstanding issues such as rotational training and training number bottlenecks with the BMA Junior (Resident) Doctors Committee an equal partner in leading and guiding that piece of work.
Does the BMA junior doctors committee recommend the offer is accepted?
Yes - the BMA junior doctors committee believe that whilst this offer does not obtain everything we seek to achieve in one step, it represents a good enough first step and the better outcome at this stage with the current level of leverage we have against the Government in their current condition. This offer moves us further along our journey to Full Pay Restoration and will continue each following year, banking wins along the way, re-entering disputes should we need to, and giving our organisation time to build capacity in between.
By accepting the additional pay for 2023-24, this would be compounded by an average 8% uplift for 2024-25, as well as for any future pay changes. Even though we believe the new offer includes several positive elements that make it an improvement over the previous one we rejected in December, it is ultimately up to you to consider it and make your own decision. Whilst there are strategies in the event of either vote, it is important to remain united and swing behind the strategy of the victorious result.
How is this offer different to the one JDC voted to reject in December?
An increased, albeit marginally, % uplift
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In December we were offered an average 2.99% uplift on existing 23/24 pay
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This offer is an average 4.05% uplift on existing 23/24 pay
No doctor left behind
- This offer encompasses above inflation pay uplifts for not only doctors on 2016 terms and condition of service but also all Locally Employed Doctors (e.g. junior clinical fellows/ trust grades), including those on 2002 terms and conditions of service.
- The offer in December would not have done this. Leaving just one doctor behind, enduring further pay erosion, was unacceptable to your committee.
- The offer in December also excluded doctors on nodal point 2 (FY2) and the uplift to NP4 (ST3/4/5) was still sub-inflationary.
Backdating
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This offer also provides backdating through to April 2023, therefore increasing the immediate value of the deal. If the offer is accepted, all junior doctors will be owed thousands of pounds of backpay, going some way to recuperate deductions members have experienced due to strike action.
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This level of backdating ensures that doctors who have undertaken strike action in the last 12 months but have since cct’ed or left the profession will also benefit.
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The offer in December would not have been backdated
See 'what would my back pay be with the offer accepted compared to without?'
2024/2025 pay uplift
- Even though the DDRB recommendation for 2024/25 was set before we entered this round of negotiations, the DDRB, which has not yet been reformed, would not have recommended an above inflation uplift (average 8%) for a second year in a row if we had accepted the offer and not taken industrial action.
Non pay:
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Additionally, whereas the non-pay reforms offered in December were piecemeal, we believe that the reforms we have secured are genuine and can have a transformative impact for doctors.
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These include reform of exception reporting, safeguarding of the FPP, as well as reviews into rotations and training numbers.
DDRB
- Finally, we agreed as part of this deal, a commitment to the future through the remit of the DDRB for next year being written (see below). There was no reference at all to the future in December’s deal and the DDRB’s recommendation for 24/25 would have been lower.
- These are in addition to the DDRB reform due to be implemented for the 25/26 pay round agreed by consultants, including no longer being given a spending constraint as part of their remit letter
We recognise the lack of trust members, and the BMA, in general, have towards these institutions. Mr Streeting wants to restore our confidence in the DDRB. This presents them with the opportunity to do so and address our erosion in pay. If they overpromise and underdeliver, and take us off our trajectory to Full Pay Restoration, we will re-enter dispute with Government and return to further strike action if needed.
Is there scope to go back to the Government for more?
This is the third offer received from this Government, which has built up from the offers previously rejected from the last Government. It is our assessment that there was nothing further we could achieve in the room, with the leverage we currently have outside the room. It is unlikely that any meaningful concessions could be achieved at this point without prolonged and escalated industrial action.
If we accept this offer now, we essentially 'bank' the pay rise with backdating proposed, and this higher pay will create the baseline from which we can go into dispute and ballot for action after April 2025 to continue pursuing pay restoration, should the DDRB fail to deliver on its reforms, and the Government fail to instil confidence in the process. We are conscious that this offer does not fully address long-standing pay erosion. What this offer does do, is improve basic pay, in both actual and real terms, for both 2023/24 and 2024/25, as well leaving no doctor behind, and this improvement will be further built upon as we continue to move towards achieving FPR.
I don’t think the offer goes far enough. Why was it presented to me?
We acknowledge this offer does not constitute full pay restoration. However, your committee believes this is a credible first step in restoring your pay, on top of the other reforms we have gained. If we accept this offer, it will add a cumulative 4.05% to the DDRB recommendation for 2023/24, which would in turn be compounded by the DDRB recommendation for 2024/25. The resulting pay uplift would be a 22.3% average increase over the two years.
While this marks a change in the trajectory of our pay, we recognise this offer would only be the first step towards achieving full pay restoration. We will remain on average 20.8% behind (compared to 31.7% behind at our peak), signifying 1/3 of the journey to FPR being complete. That said, given the circumstances and context we’re in, we believe there is greater benefit in banking this offer, which goes a long way in addressing the impact of the cost of living crisis since the pandemic for a lot of our members.
We are clear that this deal does not represent the culmination of our work to achieve FPR. Rather, it represents an opportunity to agree positive changes to our pay and the contract.
We have an opportunity to reaffirm our workplace power, strengthen our campaign strategy, replenish personal strike funds, as well as ramp up our central strike fund with new ARM policy, ready if needed for the second phase of our campaign for full pay restoration. It is our view that this offer, to be built upon each year, is the best way to achieve full pay restoration for doctors in England. If the DDRB’s reforms which are due to come in for 25/26 do not inspire confidence, take us off track for FPR, and especially if the Government does not correct it, we will re-enter dispute and if needed, ask you to take strike action again.
Following 16 months of industrial action we do not think we could make the decision as to how we proceed without consulting with you, our members, first. We are a democratic union and you are the ones who must decide on our next steps. If you accept this offer we will be banking the progress made so far with clear tests for Government and the DDRB that if we don't continue on the path of our current trajectory to pay restoration, strike action will be inevitable.
The starting salary of junior doctors is still less than PAs. How is this acceptable?
Let us be clear, this is not acceptable. However, this dispute is not about PAs and the threat they pose to our profession and patient safety. The BMA has already done much work in establishing safe parameters on the scope of practice of PAs and will continue its campaign to ensure that the boundaries between doctors and PAs are not blurred. Regardless, we tried to address the discrepancy on pay between the two staff groups, and explored frontloading, but that would have necessitated an extremely uneven distribution of the funding. Our principle has been that all doctors have experienced pay erosion, and therefore any offer should be distributed as evenly as possible across all pay points.
Following the commitment to future reforms we have obtained in the DDRB, we expect the DDRB to resolve this discrepancy in pay. It forms part of the expectations we have for 2025/26, and one of the bars we are setting for the DDRB. If they fail to, we will re-enter dispute.
What happens if the offer gets accepted?
If the offer gets accepted, it will become a deal, the current dispute around 23/24 and 24/25 will be considered resolved, and the BMA will not continue with any strike action as part of this dispute. We will move to agree to the necessary changes for these proposals to be implemented as soon as practicable. It is likely that additional payment would not be received until November 2024 due to requirements of the payroll system, but the payment would be backdated to 1 April 2023.
We will also proceed immediately with the three workstreams on non-pay issues (exception reporting, rotational training, training number bottlenecks) with a view to completing the changes to exception reporting within this calendar year.
Most importantly, we will be organising our campaign on the ground, taking the time to engage reps, activists, and all other doctors for the next steps to FPR. This could mean improving our membership density, training for reps, local organising to improve our bargaining infrastructures and more. When 25/26 comes round, we will hold the Government to account on what it asks of the DDRB for its pay recommendations to make medicine an attractive career choice ‘as it once was’. For us, this means full pay restoration, restoring the value of being a doctor. We have heard Mr Streeting describe a journey to fair pay, and if the 25/26 DDRB reforms take us off our journey along our current trajectory to FPR, and the Government does not correct it, we will immediately re-enter dispute. This time will have given us an opportunity to strengthen our workplace and industrial power and effectively utilise it, should we need to.
Would accepting the offer mean we can’t pursue industrial action again?
No. While accepting this offer will mean a resolution to this dispute, we reserve the right to re-ballot the membership at any point if necessary. There is nothing binding us to not ballot the very next day. Given the DDRB reform coming in for 25/26, and the expectation to continue our journey to FPR, we will expect a timely, significantly above inflation uplift which continues our trajectory to FPR. If any step of this process is missed, and the Government does not correct, we won’t be able to have confidence and will have no option but to re-enter dispute and re-ballot for strike action.
What happens if the offer gets rejected?
If the offer gets rejected, then the offer is off the table and will not be implemented. It is our judgement that it is unlikely that they would be willing to make meaningful concessions without significant pressure being applied through sustained and prolonged industrial action, and/or effective coordinated action with other strong unions. Given where we are in the calendar year, we also believe the backdating element will be exceptionally difficult to achieve in the future. Consequently, if you reject this offer, we will be re-balloting for a mandate to strike action and you must be willing to take strong, more escalated strike action.
How did the strikes and negotiation process impact the DDRB recommendations in 2023/24 and 2024/25?
We have only reached this position because of your refusal to accept below-inflation pay awards. Your strike action has clearly influenced the DDRB; its recommendation for 2023/24 and 2024/25, along with the offer from the Government, would lead to the highest pay award of any public sector worker over the last two years. This is a significant contrast to the DDRB that oversaw our pay erosion and absolute proof that your strike action has been effective.
We are also in no doubt that the agreement we have secured on DDRB would not have been possible without your action. This, along with the reforms agreed by consultants coming in for the 25/26 pay round, will set the bar for the DDRB to continue providing uplifts that keep us on the journey to achieving FPR. If they fail to do so, and the Government fails to correct, we will be re-entering dispute, and will ask doctors to again take strike action.
Why are we giving up the rate card?
BMA rate cards do not enforce rates. Doctors sticking together, and refusing to work for low, unacceptable rates, is what enforces more appropriate and acceptable rates from employers.
Withdrawing the rate card was a concession requested by the Government from the start and has been part of the offers put to consultant and SAS colleagues previously. We would also highlight that we accepted this on the basis that we would gain the concession regarding the flexible pay premias.
The purpose of the rate card has always been to inform doctors of their rights and empower them to value their extracontractual time appropriately. We believe that this educational exercise over the last year has been successful and there is nothing stopping individual doctors to demand to be appropriately remunerated for their work. There is also nothing stopping the BMA from negotiating collective rates locally or regionally through the appropriate structures.
What’s more, we reserve the right to re-introduce the BMA rate card for doctors if there is a future industrial dispute (including regionally).
Would accepting the offer mean I can’t negotiate my rates for extra-contractual work?
No. Even if the BMA rate card for junior doctor extra-contractual work in England is withdrawn, doctors can continue to quote whatever rates they wish for this type of work.
What commitment have we secured for future years?
We have secured the following wording in terms of the remit the Government will give to the DDRB.
“The government acknowledges concerns raised by the BMA and other parties that the medical profession is not as attractive a career prospect as it once was. The Secretary of State for Health and Social Care would therefore like the DDRB to consider, as part of its pay recommendations, the overall reward package and career progression for junior doctors to ensure that medicine is an attractive and rewarding career choice to deliver our consultants and GPs of the future”.
This aspect is something we raised with both Conservative and Labour Governments. After multiple iterations, this wording is as far as they were willing to go. Whilst we recognise this wording could go further, it sets a baseline for Government and the DDRB to continue to provide uplifts above inflation, and thereby continue to address the pay erosion experienced by doctors.
It is important to note that there are other reforms to the DDRB, agreed by our consultant colleagues, due to come in for the 25/26 pay year.
The prospect of HMT to commit in writing to pay erosion, restoration, or future (significant gains), would require more leverage than we currently have and therefore would need to be increased to get more concessions.
Wording going further than what we have would of course be welcome, but in the absence of earned trust, actions speak louder than words. We have seen commitments in other nations from Governments with more trust than ours being rowed back on. And conversely others, which whilst not to RPI, can have the potential for progress. The dynamic between devolved nations are different, but the common feature to all nations, is the readiness of doctors to fight.
The only meaningful commitment for doctors in England is ours, to re-enter dispute and take strike action any and every year we need to in the face of unsatisfactory uplifts taking us off our trajectory for FPR. Rather than trusting a commitment from our government which has not yet earned it, we should be trusting ourselves, colleagues, and union to have our back, as our colleagues in other nations are, any and every year.
We remain committed to achieving FPR. You have given us a mandate to achieve that over a number of years. Accepting this offer move us closer to achieving this. Should Government fail to meet our expectations, we will not hesitate to resume our industrial action.
Will the exception reporting changes be contractual?
We have secured confirmation that the changes will be contractual and also agreed by the end of this calendar year.
How will the changes to exception reporting be different from the status quo?
- Remove supervisors from the process.
- Draconian deadlines removed.
- Remove requirements to justify
- Lower threshold of scrutiny for everything under 2 hours.
What would my back pay be with the offer accepted compared to without?
Assuming the back pay is implemented in November 2024, please see the table below. As titled, this is basic pay only and so gross values would be increased when incorporating supplements for additional hours/out of hours etc.
These values reflect gross pay (pre tax, pension, student loans).
| Backpay based on full-time salary (basic pay only) for a: | 4% deal | No deal |
|---|---|---|
| FY1 doctor, starting in August 2024 | £1,406 | £981 |
| FY2 doctor, started FY1 in August 2023 | £3,776 | £2,061 |
| ST/CT1 doctor in August 2024, started FY2 in August 2023 | £4,887 | £2,291 |
| ST/CT2 doctor in August 2024, started ST/CT1 in August 2023 | £5,931 | £2,423 |
| ST/CT3 doctor in August 2024, started ST/CT2 in August 2023 | £6,379 | £2,652 |
| ST4 doctor in August 2024, started ST3 in August 2023 | £6,439 | £2,880 |
| ST5 doctor in August 2024, started ST4 in August 2023 | £6,384 | £2,880 |
| ST6 doctor in August 2024, started ST5 in August 2023 | £6,643 | £3,036 |
| ST7 doctor in August 2024, started ST6 in August 2023 | £7,095 | £3,193 |
| ST8 doctor in August 2024, started ST7 in August 2023 | £7,192 | £3,193 |
If you are a GP registrar who is on the 2023/24 or should be on the 2024/25 Flexible Pay Premia rates, you will also get back pay for FPP, which will increase the amount of back pay you receive.
| With deal | Without deal | |
|---|---|---|
| GP ST1 | £5,220 | £2,485 |
| GP ST2 | £6,454 | £2,423 |
| GP ST3 | £6,379 | £2,652 |
| CCT Aug 24 | £4,273 | £1,440 |
The above figures were calculated on the assumption of full-time basic pay for the entire backpay calculation period of April 2023 to November 2024, and on the assumption that ST1 and ST2 doctors were eligible for the maximum amount of FPP possible. ST1 doctors would have to be eligible for FPP for the duration of the 4 month period August to November 2024, and ST2 for the duration of the 16 month period August 2023 to November 2024 (both inclusive) to receive the figures in the table above.
The actual amount received will depend on time worked and time eligible for FPP. Your back pay could be higher or lower depending on your individual circumstances.
The English pay offer and public health registrars
The details below aim to provide information and answers to some of the most common questions public health registrars are asking about the latest pay offer in England for junior doctors. Further detail about the offer, including the exact offer letter can be found here.
Will I be able to vote?
You must be a BMA member to vote, you can join now and pay nothing for 3 months if you are not already a member. All public health registrars who are BMA members will get a vote. Please make sure your account details are up to date, ensuring that public health is your primary specialty/branch.
What does this offer mean for public health specifically?
The offer will not affect public health registrars in a different way to other specialties/doctors, other than particularly benefiting from the higher increase to nodal point 3. However, many members will take a wider context when voting. Some public health registrars have expressed sentiments about their clinical colleagues/the FPR campaign, especially when they have not been on strike themselves in certain cases. Ultimately, it is up to you what you consider when you vote.
Why is the junior doctor committee recommending this?
See above for answer to this question.
Was this the first offer?
See above for answer to this question.
Were other items, such as exam fees, considered in negotiations?
Yes, but the government insisted that funding for these items would have to come from the overall funding envelope and therefore would mean a lower pay uplift. Your negotiators took the view it was better and fairer to invest any available money into overall basic pay.
How could/would we go back into dispute?
Entering trade dispute is a relatively simple process. It could be entered into immediately following a poor future pay offer if no meaningful negotiations occur. Your committee could then consult membership and urgently meet. If voted for, the BMA would then re-enter dispute and could re-introduce its rate card and a ballot for industrial action.
How will pay restoration be secured in future?
See above for answer to this question.
What could/would be the results after a rejection?
See above for answer to this question
Is this not a small amount given all the action?
Your negotiating team argued for higher pay uplifts, but this was the highest the government were willing to give. However, your action has undoubtedly inflated both the 23/24 and 24/25 DDRB awards in addition to getting this offer. This extra consolidated 4.05% is still significant, especially when backpay and additional/enhanced hours supplements are considered.
What does this mean for existing pay disparities between GMC and UKPHR registered public health registrars if accepted?
If the offer is accepted, it will widen the basic pay gap for equivalent registrars on medical/dental contracts vs. Agenda for Change (AfC) in England. Regardless, many AfC registrars are pleased for their colleagues and want them to vote. The BMA is committed to ending pay disparities in public health and we’re meeting with our AfC colleagues to discuss the offer.
What does PHMRS think?
The public health medicine registrar subcommittee send a representative to the resident doctor committee and its executive, who acts as a liaison on English pay and contract matters. These are negotiated by the resident doctor committee. We are aiming to inform and educate our members, urge them to vote and to note the resident doctor committee recommendation.
Who is eligible to vote in the referendum?
- All junior doctor BMA members with an NHS employer in England
- Locum junior doctors employed directly by an NHS employer in England
- BMA members who were added to the GMC GP and Specialist registers between 01/03/23 and 31/08/24 but who were junior doctors in England during the strike period employed by an NHS employer
- All public health registrars and medical academic registrars in England
- Final year medical students who are expected to qualify in 2024 and have or are expected to have an NHS employer in England
- Doctors who were striking in England at the time of industrial action and have since moved to a devolved nation
If you have received a voting link, but are not eligible to vote in the referendum, please let us know so we can have you excluded from the total vote count. This applies whether or not you have voted.
If you still have questions about your eligibility to vote, please email us.
How do I vote in the referendum?
The online referendum opened on 19 August and closes at 11.59pm on Sunday 15 September.
Eligible members should have received their unique voting link via email on Monday 19 August. Simply follow the link from [email protected] to accept or reject the offer.
Before casting your vote, be sure to read the offer details and check your emails for the latest updates from the committee.
Voting takes less than two minutes, so please don’t let the decision be taken out of your hands – vote!
I've not received my email to vote
Update your details
Following inductions and rotations, many members are yet to update us on their current employer and place of work. You won’t be sent a voting link until we have these details so log in to your account and check we have the correct information for you.
Please note − if you have only recently joined the BMA or made updates to your place of work information, you will not have received a voting link on the day the referendum opened. New members and members with changes to their membership details will receive their voting link email within a week.
Check your spam folders and request a new link
See our support for junior doctor members in England who can’t find or didn’t receive a voting email.
Where can I find out more about the offer?
We held a series of national and regional webinars to go through the offer in more detail. Thank you to everyone who has attended, we hope you found the sessions informative and feel more prepared to make your vote.
If you were unable to make it to a webinar, you can watch a recording below.
If you still have questions, please email us.