Senior figures within trade unions have privately voiced significant misgivings regarding the upcoming doctors' strikes, expressing frustration over the conduct of negotiations and the specific pay demands put forward by the British Medical Association. The BMA is currently pushing for a pay increase that exceeds the 3.5% offer extended to doctors by the government, with a series of strikes scheduled to commence next week.
Disparity in NHS Pay Offers Sparks Tension
In contrast, more than one million NHS staff who are not doctors—including nurses, physiotherapists, midwives, healthcare assistants, ambulance workers, and hospital porters—are set to receive an even lower pay rise of 3.3%. This figure is determined through the Agenda for Change system, which governs pay scales for non-medical personnel. The BMA's insistence on a higher percentage has reportedly caused resentment among other unions representing NHS staff, particularly those whose members' pay is tied to the AfC framework.
One senior union figure highlighted the growing difficulty in presenting these deals to their members, stating, "The agreements we have been able to present to our members are becoming a much tougher sell." Another source criticised the leadership of the BMA, suggesting that having resident doctors, rather than professional negotiators, at the helm has led to a chaotic approach to talks. "I think it stops from taking any kind of pragmatic approach," they remarked.
Concerns Over Negotiation Tactics and Broader Impact
The first union source elaborated on this point, arguing that resident doctors leading the negotiations results in less willingness to compromise on pay and conditions that affect new entrants into the workforce. "You need to zoom out sometimes and I don't think they can see the bigger picture," they added. A third senior union source acknowledged "undoubtedly resentment" among unions representing non-doctor NHS staff, noting a perception that the government always "seemed more willing to listen to the doctors." However, they also conceded that the BMA is merely fulfilling its role by advocating for the best possible deal for its members.
Further complicating matters, the GMB union is in dispute with the BMA due to a pay offer made by the BMA to its own staff. BMA staff are planning to strike concurrently with the six-day resident doctors' strike on 7 April, as the BMA's most recent pay offer to its employees of 2.75% falls below the 3.5% recommendation for resident doctors.
BMA's Defence and Ongoing Pay Struggles
In response, a BMA spokesperson defended the union's stance, emphasising that doctors have experienced a more than 20% real-terms pay cut since 2008-09. "This year's award of 3.5% was never going to be acceptable as it makes no progress whatsoever at reversing these real-terms pay cuts," they stated. The spokesperson also highlighted the unique position of doctors compared to BMA staff, pointing to competitive pay and benefits within the BMA and high staff retention rates.
Meanwhile, NHS staff under the AfC deal have yet to begin discussions about the broader structure of their pay, with their unions likely to push for reforms to pay scales. A recent Unison analysis of NHS data for England over three years reveals no significant improvement—and in some cases, a decline—in pay satisfaction levels among workers on AfC contracts. In contrast, medical and dental staff are the only group where pay satisfaction has shown any notable increase, rising by 18 percentage points since 2023. Unison indicated that these findings underscore how many NHS employees continue to feel undervalued, with little change under the new government.
