My brother phoned me last week: “Keir Starmer has threatened to cut 1,000 additional training posts for resident doctors if they don’t call off their strike!” He seemed excitedly scandalized by this Trumpian turn of events, with Starmer effectively saying: if you don’t do what we want, we’re going to hit you where it hurts. There is clearly deep frustration in the government at its inability to resolve the resident doctors’ dispute.
Labor inherited a triple mess from the Tories. Resident doctors’ real wages fell more than almost any other workforce during the austerity measures. The failure to expand postgraduate training capacity to accommodate the growing number of medical school graduates, together with visa changes that opened up the NHS to large numbers of overseas doctors, left a generation of UK-trained doctors with damaged career prospects or unemployment. And the botched introduction of physician associates (PAs) – a new NHS role that requires only a fraction of the training that doctors undergo and who earn far higher wages than many residents – only compounded the demoralization in the ranks.
Health Secretary Wes Streeting has tried to address the issues. Significant wage increases for residents have eased some, but not all, of the tensions. These additional postgraduate training places – subject to Starmer’s threat – together with the recent Medical Training (Priority) Act, which ensures that UK-trained doctors are preferred for training jobs over overseas doctors, should start to improve career prospects. And while associate physician salaries remain anomalous, the Leng Review, commissioned by Streeting and published last summer, appears to have gone some way to avoid the practice of replacing resident physicians with PAs.
The latest breakdown of talks, however, illustrates the fundamental gap. The government argues that, however fiscally constrained, it has been as generous as it can be; Residents should be grateful for what they have. This line is certainly finding sympathy with some members of a public weary of yet more industrial action. But I do not believe that resident physicians will – or should – retire.
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The medical profession as a whole feels that its values and very existence have been progressively degraded over the past 15 years. The PA scandal is just the most visible evidence of a prevailing belief in policy circles that much of what expensively trained doctors do can be provided by less qualified, cheaper staff. Resident physicians’ aim for full-fee restoration has become totemic in a battle to preserve the profession. There is a vested interest in this, of course. But there is also a genuine belief that patients deserve the quality of care that only rigorous medical training can provide. I suspect that the British Medical Association – in common with many in the wider profession – believes that we are at a point of no return. Reach the wage restoration totem and there is a chance to save the potion. Buy your eyes or lose your heart and all we will see is an inexorable decline and degradation.
Talks may yet resume, and by the time this column goes to press, industrial action may have been averted. But of one thing I am sure: if the strike is called off, it won’t be because of Starmer’s threat. If I had to make a prediction, I suspect it will continue: another clash that is presented in the media about what doctors take home, but it’s about something more fundamental.
I’m sure Streeting understands the true nature of battle lines. In the background, the General Medical Council is consulting on plans, led by the Department of Health and Social Care, to open its specialist register to non-doctors. At some point in the future, the “cardiologist” or “oncologist” or “surgeon” you see – to say nothing of “your GP” – may not have had medical training. Those who run the NHS think this will be fine. Most members of the medical profession strongly disagree.
(Further reading: Trump’s Roadless War)
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