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

Are NHS workers in England taking industrial action in Summer/Autumn 2024?

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

Most NHS staff, including nurses, paramedics and some non-clinical staff, are paid on a scale called Agenda for Change. Doctors are paid on a different scale. General Practices are independent businesses that are contracted to provide NHS services, so their staff are not directly employed by the NHS.

Doctors

General Practitioners

On 1 August 2024, the BMA announced that GP contractor/partner members in England have voted to take collective action. Collective action refers to actions taken by general practices that do not breach their contracts. The BMA has produced a list of ten actions that practices can take, including limiting the daily patient contacts per clinician to 25.

Collective action can carry on indefinitely. The BMA has said that “phase two” of action could include actions that breach contracts, for example taking strike action.

The collective action is taking place in response to funding for general practices and the national contract.

On 29 July 2024, the government announced it would “accept in full” the recommendations of the independent pay review bodies. This would be reflected in the overall funding uplift for general practices. However, the BMA said this is not enough “to tackle the erosion of practice finances over the past five years”.

Junior doctors

There are no junior doctor strikes currently planned.

Junior doctors are represented by two unions, the British Medical Association (BMA) and HCSA – the Hospital Doctor’s Union.

On 29 July 2024, the BMA announced it would put a pay offer to its junior doctor members in England following negotiations with the new Labour government. The BMA’s Junior Doctor Committee has recommended that members accept the deal.

If members vote to approve the offer, the current dispute with the government will end and no further strike action will be taken. Junior doctors in England represented by the BMA have a mandate to strike until 19 September 2024.

HCSA has said its Junior Doctor Committee is considering the offer. HCSA’s junior doctor members in England do not have a mandate to continue strike action. HCSA held a reballot of its junior doctor members in England in April to June 2024. Whilst 95% of those who voted were in favour of continued strike action, the percentage of members that voted was narrowly below the legal threshold required to secure a strike mandate. HCSA said it would not rule out the possibility of a future strike ballot (see ‘What does the law say about voting to strike?’ below).

Junior doctor members of the BMA in England last took strike action between 27 June and 2 July 2024.

Consultants

There are no consultant strikes planned.

On 5 April 2024, the BMA’s consultants committee accepted a government offer on pay for consultants. The offer also included reform of the Review Body on Doctors’ and Dentists’ Remuneration (DDRB), which makes recommendations to government on doctors’ pay.

Specialty and specialist doctors

There are no strikes planned by specialty and specialist (SAS) doctors. SAS doctors mostly work in hospitals alongside junior doctors and consultants.

SAS doctors represented by the BMA in England voted on a revised pay offer from the government between 31 May and 14 June 2024. On 18 June 2024, the BMA UK SAS committee announced members had agreed to accept the offer.

Agenda for Change Employees

Some Agenda for Change (AfC) employees are engaged in local industrial action but there are no national strikes planned.

There are several trade unions representing AfC employees. Some 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.

Members of AfC unions initially began strike action in response to the 2022/23 pay deal (see ‘Why did NHS workers start striking?’ below). In May 2023, an AfC pay deal for 2022/23 and 2023/24 was accepted by majority vote, but 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. Unite, the Society of Radiographers and the Royal College of Nursing voted against the offer and said they would continue strike action.

Nurses

The RCN does not currently have a mandate to strike.

Although the RCN voted against accepting the 2023/24 AfC 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.

Allied Health Professionals and other NHS workers

The Society of Radiographers wrote to the Health Secretary following the pay offer to consultant doctors. 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 then Health Minister Andrew Stephenson MP.

Members of Unite are continuing to take strike action at some Trusts in England over pay and safe staffing levels. Strikes have also been 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.

2024/25 pay awards

On 29 July 2024, the government announced it would “accept in full” the recommendations of the independent pay review bodies.

The Review Body on Doctor’s and Dentists’ Remuneration (DDRB) recommended a 6% increase to salary scales, pay ranges and pay elements of contracts from 1 April 2024. This applies to consultants, SAS doctors, doctors and dentists in training, salaried dentists, contractor general medical practitioners, salaried GP pay ranges and the pay element of dental contracts.  It also recommended an additional consolidated payment of £1,000 for junior doctors.

The BMA said the above-inflation pay lifts are a sign that the government “is beginning to recognise the value of doctors”. However, it also said that GPs would be disappointed with the deal as it does not “meaningfully address” GP pay erosion.

The NHS Pay Review Body (NHSPRB) recommended a consolidated 5.5% increase for all AfC staff from 1 April 2024. It also recommended adding further pay points at band 8a and above.

The Royal College of Nursing said it will launch an online consultation to understand how its members feel about the pay award.

Unite criticised the offer, saying “health workers being offered less than half of what junior doctors have been offered is not good enough.” Unite will ballot its member to get their views on the pay deal.

2023/24 pay agreements

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. Following negotiations with the government, the following agreements were reached.

Junior Doctors

Junior doctor members of the BMA in England will vote on a pay offer agreed in July 2024. The offer includes an additional 4.05% for 2023/24 on top of the previous uplift set out in July 2023. This would be backdated to April 2023. The BMA says that combined with the pay award for 2024/25(including consolidated elements), this represents an uplift of 22.3% on average over the two years of the pay dispute.

Consultants

On 5 April 2024, the BMA’s consultants committee accepted a revised pay offer. This offer includes an additional 4.95% investment in pay for consultants (as set out in a previous, rejected offer) as well as a newly agreed 2.85% (£3,000) consolidated uplift for those who have been consultants for between four and seven years. This is on top of the previous 6% uplift for 2023/24 and separate to a 2024/25 pay award. The pay elements will be backdated to 1 March 2024. In addition, it was agreed that reforms to the DDRB will be in place for the 2025/26 pay round.

SAS doctors

The revised pay offer accepted by SAS doctors in June 2024 includes a pay uplift between 6.1% and 9.22% for those on open, 2021 contracts (percentage varies dependent on pay point) and a consolidated pay uplift of £1,400 for those on closed, non-2021 contracts. The pay elements will be backdated to April 2024. A 2024/25 uplift would be on top of this. The offer also included actions on career progression and reforms to the DDRB.

Agenda for Change employees

In May 2023, a majority of representatives from AfC trade unions voted to accept a pay offer from the 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.

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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