This is a fast-moving topic and information should be read as correct at the time of publication.

Are NHS workers striking in Winter 2023-24?

Some NHS workers represented by trade unions have been taking part in industrial action in response to pay and patient safety concerns.

Doctors are paid on a different scale to most other NHS staff, including nurses, paramedics and some non-clinical staff, who are paid on a scale called Agenda for Change.

Doctors

Junior doctors

On 9 February 2024, the British Medical Association (BMA) announced junior doctors in England would take further strike action from 24th to 28th February. The BMA, a trade union for UK doctors, said it would be willing to call off the strikes if a “credible offer” is made.

A smaller union representing hospital doctors, HCSA, announced it would also take strike action on these days.

Junior doctors in England would went on strike in December 2023 and January 2024. The BMA rejected the Government’s offer of an additional 3% for this year, saying this would “amount to pay cuts for many doctors”.

Junior doctor and consultant members of doctors’ unions in England took joint strike action in September and October 2023. Members of the British Dental Association who work in hospitals in England also took strike action at some trusts, coinciding with the doctors’ strike.

Consultants

On 27 November 2023, the Government and unions representing consultant doctors in England agreed an offer to put to union members (see below for details of the offer). Consultant members of the the BMA voted to reject the offer. The BMA consultants committee said it had decided not to call strike action at this time and would enter into talks with the Government. However, future strike action remains a possibility if the dispute is not resolved.

Consultant members of the HCSA also voted to reject the offer.

SAS doctors

On 18 December 2023, the Government and the BMA agreed an offer to put to a third group of doctors in England, Specialist, Associate Specialist and Specialty (SAS) doctors (see below for details of the offer). SAS doctors mostly work in hospitals alongside junior doctors and consultants. A vote on the offer closes on 28 February.

SAS members of the HCSA union have rejected the offer.

Agenda for Change Employees

Some Agenda for Change (AfC) trade unions are profession-specific, such as the Royal College of Nursing (RCN), and some represent workers across the health sector, such as Unite and Unison.

The latest pay award for AfC workers was accepted by majority vote in May 2023, although not all unions were in favour.

Some unions, including GMB Union and Unison, stopped strike action after their members voted in favour of accepting the offer. Unitethe Society of Radiographers and the Royal College of Nursing voted against the offer and said they would continue strike action.

Nurses

Although the RCN voted against accepting the Government’s latest pay offer, its members could not take further strike action without a new legal mandate. It carried out a national ballot between May and June 2023 but the 50% turnout threshold required by law was not met, so strike action could not continue.

Following the pay offer to consultants in November 2023, General Secretary and Chief Executive of the RCN, Pat Cullen, wrote to the Health Secretary, Victoria Atkins, to demand new negotiations. She said the latest pay award for nurses has been “consistently eclipsed” by offers to other public sector workers.

To take further strike action, the RCN would need to reballot its members.

Allied Health Professionals and other NHS workers

The Society of Radiographers, which still has a mandate to take strike action, also wrote to the Health Secretary following the pay offer to consultants. It said there would be further calls for industrial action if the Government does not engage constructively with the union. In December 2023, the Society said it had engaged in “positive talks” with Health Minister Andrew Stephenson MP.

Members of the Society of Radiographers in England took 24-hour strike action in October 2023, to coincide with the doctors’ strike.

Members of Unite are continuing to take strike action at some Trusts in England over pay and safe staffing levels. Strikes are also taking place in response to non-payment of the “backlog bonus” element of the latest pay deal to workers who aren’t directly employed by the NHS. Unite represents workers from across the health sector, including nurses, cleaners and porters.

What are the latest pay deals?

Independent pay review bodies make annual recommendations to Government on pay based on evidence from employers, unions and the Department of Health and Social Care. The Government makes the final decision on whether to accept the recommendations.

Doctors

On 13 July 2023, the DHSC announced SAS doctors, NHS consultants, salaried dentists and salaried GPs would receive a consolidated pay uplift of at least 6% for 2023/24, backdated to 1 April 2023. Junior doctors would receive a consolidated pay uplift of 6% plus £1,250.

The DHSC made the recommendations in line with the latest report from the Review Body on Doctors’ and Dentists’ Remuneration.

Reacting to the announcement, the British Medical Association (BMA) said the Government had “missed a huge opportunity to put a credible proposal on the table to end strikes.”

In November 2023, the Government and unions agreed a new offer to be put to consultant doctors in England. The offer includes a 4.95% investment in pay for consultants for January to April 2023/24, to be paid retrospectively in April. This would be on top of the previously agreed 6% uplift for 2023/24 and separate to a 2024/25 pay award.

The amount individual consultants would receive would depend on where they are on the pay scale, which would also be reformed under the offer. The scale would have less progression points and consultants would reach the top of the pay scale sooner. The offer included other elements such as reforming the doctors and dentists pay review body and introducing shared parental leave into the consultant contract. This offer was rejected by consultant members of the doctors’ unions.

In December 2023, the Government and the BMA agreed a new offer to be put to SAS doctors in England. The offer, which is in addition to the 2023/24 pay uplift, involves changes to pay scales for SAS doctors on multi-year contracts agreed in 2021. SAS doctors on closed contracts would be able to move to the 2021 contract. The offer also includes £5 million to support NHS employers to create more specialist roles. The offer would be implemented from January 2024 and is separate to any future award decided by the 2024/25 pay review process.

Agenda for Change employees

In May 2023, a majority of representatives from AfC trade unions voted to accept a pay offer from Government in a meeting of the NHS Staff Council. The NHS Staff Council has responsibility for the AfC pay system and includes representatives from NHS employers and trade unions.

The deal includes a one-off payment for 2022/23 and a pay uplift for 2023/24. This is broken down as:

  • A one-off, non-pensionable payment for 2022/23, on top of the original 2022/23 pay award (see below), including two elements:
  • a payment equal to 2% of salary for all staff
  • a tiered “backlog bonus” payment for all staff, depending on the tier (average value of 4%). Tiers are groups of AfC pay bands, for example tier 1 includes pay bands 1–4.
  • A pay uplift of 5% in 2023/24 for most staff and 10.4% for those at band 1 and 2 entry points.
  • A series of “non-pay measures to support the workforce”, including challenging recruitment and retention issues in nursing and reviewing the process for setting pay.
  • Health Secretary Steve Barclay issued a statement saying he would implement the pay deal and NHS staff would receive their extra pay from June 2023. Information about eligibility for the pay deal, including how the non-consolidated (“lump sum”) payment applies to bank staff, can be found from an FAQ page by NHS Employers.

    Background

    Why did NHS workers start striking?

    In July 2022, based on the review bodies’ recommendations, the Government announced it was making the following changes to NHS pay, backdated to April 2022:

    • Doctors and dentists received a 4.5% increase in their salaries.
    • Employees on the AfC scale received a £1,400 permanent increase to their full-time equivalent salary (not a one-off payment), backdated to 1 April 2022.
    • Staff at the top of band 6 of AfC, and those in band 7, received a further enhancement to ensure their pay increased by at least 4%.
    • For staff in bands 1 and 2, the increase of £1,400 was in addition to National Living Wage adjustments.

    Trade unions representing some NHS workers noted the increase in pay amounted to a pay cut in real terms and argued it was too low in the context of the rising cost of living.

    Union members also said health workers want to improve patient safety, which is being compromised by inadequate staffing levels and staff burnout. They were also concerned that people would be reluctant to join the NHS or stay in their jobs without better pay, exacerbating existing staffing problems.

    These concerns led trade unions to ask their members to vote on whether to take strike action.

    What does the law say about voting to strike?

    Under the Trade Union Act 2016, for a strike ballot in “important public services” to be valid there must be a 50% minimum turnout and at least 40% of all eligible members must vote in favour.

    Under Trade Union laws, unions can ballot members at individual workplaces or organise aggregated ballots of staff who have common terms and conditions. This means the thresholds can apply to trusts or nationally, depending on the ballot.


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