The simple argument that a junior doctor working in Scotland today is not worth 28.5 percent less than a junior doctor working in 2008 has powered the British Medical Association Scottish Junior Doctor’s Committee’s (SJDC) campaign to fully restore our pay after fifteen years of inaction. 

Our campaign’s central motivation is to restore junior doctor pay and, in doing so, provide a long-term solution to the retention crisis the Scottish NHS faces. An alarming 44 percent of Scottish junior doctors have actively researched leaving the NHS over the last twelve months, and only 15 percent think they will continue working in the NHS in the long term. Junior doctors are being inundated with opportunities to move abroad, with recruiters working on behalf of the Australian government paying for trucks to picket lines carrying job adverts offering improved pay if those doctors emigrated.

This is about doctors and our ability to provide high-quality care for patients in an increasingly competitive and international marketplace where we are in short supply.  We have seen the distressing impact of staff shortages on patient care and have finally had enough.

SJDC worked tirelessly this year to win the first-ever Scottish junior doctor’s ballot for industrial action with a resounding 97 percent mandate. We used this result to negotiate with the Scottish government over a four-month period. 

On 22 May, our negotiations reached an impasse. The Scottish government made a ‘final’ offer of a 14.5 percent consolidated pay increase over two years which, in our opinion, could not be recommended. It did not address the core of our dispute as it did not provide a credible roadmap to restore pay and improve retention amongst Scottish junior doctors. To make progress, we released the offer to members neutrally and it was rejected by a majority of 71.1 percent.

We announced three days of strike action and re-entered negotiations with the Scottish government. These negotiations were significantly more productive following the rejection of the 14.5 percent offer. On 7 July, we announced an improved pay offer had been negotiated and would be put to members in a second consultative ballot with a recommendation to accept. This offer was accepted by a majority of 81.64 percent last week. 

The new offer gives Scottish doctors a single-year pay uplift of 12.4 percent backdated to April. This represents a consolidated rise of 17.5 percent over two years in comparison with the previous offer. Crucially, it contains a commitment to direct pay negotiations each year until 2026 to agree further uplifts that must ‘make credible progress’ in real terms towards full pay restoration. Inflation will be guaranteed as the floor for each round of ongoing negotiation, above which additional pay uplifts must be agreed.

The offer also includes a commitment to effectively withdraw Scottish junior doctors from the Doctors and Dentists Pay Review Body (DDRB)—the supposedly independent government body responsible for making pay recommendations, which has resulted in years of falling pay driving the NHS crisis—through the formation of a new pay review mechanism which aims to reach a ‘mutually agreeable path to achieve pay restoration and prevent erosion recurring in the future’ along with a commitment to wider contract reform to improve the working lives of Scottish junior doctors by 2026. Should commitments be broken, the SJDC will re-ballot and take industrial action if needed. 

The 12.4 percent represents small real terms rise above inflation. The size of the uplift reflects a compromise reached with the knowledge of the pressure that acutely high inflation places on a devolved nation budget which is formed predominately from a fixed grant from Westminster with only limited devolved tax, borrowing and reserve powers. Going forward, as inflation and budgetary pressure ease, greater real terms yearly rise will be needed—and expected—to take us towards full pay restoration. 

Ongoing direct pay negotiations each year until 2026, with inflation set as the floor from which progress must be made to fully restore pay, is a hard-won concession and should be seen as the reason the offer has been accepted by junior doctors in Scotland. This unprecedented commitment provides a structure for SJDC to continue making progress towards full pay restoration, either at the negotiating table or by re-balloting and striking if commitments are broken within the three-year timeline. 

The withdrawal from the DDRB and the formation of a new pay review body is an essential step to sustain our campaign over the long term. This body has provided political cover for the 28.5 percent real terms pay cut junior doctors in Scotland have received since 2008. Whilst supposedly independent, the body’s members are appointed solely by the UK government, it has budgetary limits imposed on it by government prior to making its recommendation, and its recommendations are not binding. Indeed, ministers are more than happy to override their supposed ‘independence’ when the objective is to keep pay low. Continued use of the DDRB cannot continue if we are to undo the damage caused by UK governments to the medical profession and we are pleased the Scottish government now accept this.

The agreement we have reached provides a stark contrast to the ongoing and increasingly bitter dispute in England, where junior doctors have campaigned to reverse their 31.7 percent real terms pay cut since 2008. After five rounds of industrial action, Rishi Sunak’s government have imposed the DDRB recommendation of a 6 percent uplift and a one-off consolidated payment of just £1250, calling it their ‘fair and final’ offer and publicly refusing further talks to discuss pay. 

The Scottish government engaged with SJDC following the ballot result, negotiated without preconditions, and worked with us to produce a structure that takes us forward. In contrast, the UK government have failed to negotiate without preconditions demanding that junior doctors in England abandon their ask for full pay restoration and pause industrial action prior to any talks taking place.

The stance taken by the UK government is particularly frustrating given that the fiscal ability of the UK government to grant full pay restoration in one year, or as part of a fixed multi-year pay deal, is significantly greater than that of the Scottish government. The news that Rishi Sunak has already spent the £1 billion needed to grant full pay restoration to English junior doctors on providing cover for their ongoing strike action should make this clear. The UK government is being driven by rigid and short-sighted ideology in their handling of this dispute. 

If Scotland can produce a credible path to full pay restoration despite the financial limitations of a devolved government, England must do so too. However, a continued war of attrition seems inevitable as English junior doctors re-ballot to take their action into winter and battle lines are drawn in the English media, characterising their representatives as ‘militant’ for holding out for a more substantial offer.

In Scotland, our work will now accelerate. The SJDC will agree terms of reference for the new pay review body, the contract renegotiation, and the timeline for yearly direct pay negotiations with the Scottish government. These must be agreed before our current ballot period ends. We expect to know whether credible progress is being made toward full pay restoration in negotiations by the start of next year. If it is not, we will begin preparations to re-ballot for industrial action. 

It has taken a huge effort from everyone involved to reach this point, but Scottish junior doctors have shown that a path towards pay restoration is possible in a devolved nation. We have shown we are ready and willing to fight for the improvements in our pay and conditions that our profession and our health service needs to survive.