There are big changes to industrial relations for resident doctors in England.
We have fundamentally changed how we negotiate and bargain, moving away from an ad-hoc system that depended on whether the Government or NHS Employers wanted to engage, which is important as we can now get on with the implementation of the deal we have secured.
Instead, we have created a formal industrial relations framework that brings every decision maker into the room and gives resident doctors a structured way to negotiate on behalf of every resident in England.
None of this changes the foundation of our bargaining power and the thing underpinning all of this: our ability, and willingness, to organise and take industrial action remains exactly the same.
If the the Review Body on Doctors' and Dentists' Remuneration fails to deliver, or if we need to escalate the fight over pay, London weighting, rotas, annual leave, recruitment, progression or any other part of our terms and conditions – we can and must take action as a collective. That is what underwrites everything and it is always within our power to do so.
This new structure strengthens our ability to negotiate; it does not replace our ability to take action. We must not shy away from needing to take action.
Before talking about the national changes, I’ve seen first-hand what a proper bargaining forum can achieve. I’ve been chair for the northern region for almost two years. Every resident doctor in training in the north of England has the same lead employer, creating a huge opportunity to negotiate region-wide improvements.
When I took over, there was no formal negotiating structure – just occasional meetings with HR four times a year. I promised, and then established, a joint local negotiating committee led by resident doctors. Since then, we’ve used it to pursue legal action over widespread underpayments, challenged a £1m reduction in mileage rates, are negotiating a new regional annual leave policy and created a formal route to hold the Dean and employer to account. None of that existed 18 months ago.
The same principle will now applies nationally.
The resident doctors industrial relations committee
As part of this agreement, we’ve established the resident doctors industrial relations committee – a permanent national negotiating forum bringing together the BMA, NHS Employers, NHS England and, crucially, the Government.
That matters because, until now, national negotiations have largely happened only when the Government chose to engage. For the past few years there has been no formal bargaining forum at all and before that negotiations were largely conducted with NHS Employers, with the Government involvement only when it suited them.
The RDIRC changes that. It creates regular, structured negotiations with everyone responsible for the decisions which affect resident doctors. Whether the issue is failures in recruitment processes, annual leave issues, widespread late rotas, unfair progression arrangements, national employment policies or implementation of this agreement. There is now a formal mechanism to negotiate and escalate issues.
Just as importantly, this is absolutely not a return to the old way of working and is quite far from it. NHS Employers is no longer the only organisation across the table, as it has been for almost a decade. The Government cannot just wander in and out whenever it feels like it, leaving the rest to others. Government and NHS England now have formal responsibility within the process, meaning those with the power to make decisions are present and accountable.
The RDIRC is an enforcement mechanism for this agreement and a standing bargaining forum for future improvements. It gives us a permanent seat at the table while preserving the thing that secured these changes in the first place: our ability to organise and, when necessary, take industrial action.
Next steps and the deal
FLETCHER: Prepared to use collective strength of doctors
The first meeting of the RDIRC takes place this week and we’ll be using it to hold every party’s feet to the fire over implementing the agreement we’ve just secured.
The first item on the agenda is substantive (permanent) contracts for LEDs (locally employed doctors), which the Government committed to begin introducing from August 2026. There will inevitably be an implementation period but this cannot turn into an excuse for delay. The commitment was clear from August and we will be holding every party to it.
We all know why this matters. LEDs deserve the same job security as other NHS staff and we must break the endless cycle of reapplying for your own job every year, or the uncertainty that comes before changeover when fixed-term contracts come to an end. In the real world, this means ending unnecessary uncertainty affecting LEDs with mortgage applications, financial planning and last-minute uncertainty for those with visas. Every other major NHS workforce has access to substantive employment – it is time resident doctors did too.
Alongside this, we’ll be driving rapid implementation of the rest of the agreement: exam fee reimbursement, additional jobs, less-than full-time progression reforms and every other commitment that has been made as part of the offer that is now a deal.
We’ll be pushing for progress on every front and holding NHS Employers, NHS England and crucially, the Government to account for delivering it. If there is any sign of delay, or back stepping then we must remain ready to use our collective strength to take action.