What are we doing differently in Scotland?

by Hugh Pearson

Why the Scottish junior doctors committee recommended accepting the Scottish Government’s pay offer, and how it moves us forward in the campaign for full pay restoration in Scotland

Location: Scotland
Published: Thursday 17 August 2023
Out in force: junior doctors strike. 13 March, Barts

On Friday 7 July, as English junior doctors prepared for a record-breaking five days of industrial action, the SJDC (the Scottish junior doctors committee) announced that an improved pay offer had been negotiated with the Scottish Government, that we were unanimously recommending our members accept it and that industrial action was paused.

The offer has now been accepted by Scottish junior doctors with a vote of 81.64% to accept, with a turnout of 71.24%.

We believe this offer, whilst representing a compromise, is the best platform for Scottish doctors to practically move forward in this dispute. Whilst the recommendation to accept has been controversial to some, we remain confident our strategy will successfully reverse our 28.5% real-terms pay cut within five years.

The offer has three parts.

First, Scottish junior doctors will receive a single year salary increase of 12.4% backdated to 1 April for the year 2023/24, a total investment of £61.3m. This is a small above-inflation uplift for this year, whether you measure inflation using RPI (Retail Price Index) – 11.4% or CPI (Consumer Price Index) – 8.7%. It represents a consolidated increase of 17.5% over two years, compared with the 14.5% increase offered previously by the Scottish Government.

This single year uplift is not the reason SJDC recommended members accept the offer from Scottish Government. Whilst this uplift is the ‘largest in the last 20 years and the best offer in the UK’, we are fully aware it makes only a small amount of real-terms progress towards fully restoring our pay.

We see this year’s uplift as a compromise that is necessary in the context of record inflationary pressure on a budget which is dependent on a fixed grant from the Westminster Government with only limited devolved tax, borrowing and reserve powers. This situation is in stark contrast to England, where the fiscal flexibility available to the Westminster Government is far greater. Indeed Rishi Sunak’s government has already spent the full £1bn needed for pay restoration for English junior doctors on providing cover for their ongoing strike action in England.

We acknowledge – as does the Scottish Government – that a similar real-terms percentage increase will not be acceptable next year as inflation eases. We are clear that the Scottish Government must initiate the necessary budgetary preparation for this immediately and SJDC will need to see that this has started before the end of our current ballot period.

It is the second part of the offer that represents a hugely significant step forward in this dispute for Scottish junior doctors. For the next three years, SDJC will negotiate pay uplifts directly with the Scottish Government ‘with the aim of agreeing an uplift that is substantial enough in real terms to make credible progress on the path towards pay restoration’. In each round of negotiation, yearly inflation will be guaranteed as the floor of that year’s pay offer from which we will negotiate up.

This is an unprecedented commitment. It moves us from a position where pay restoration was a strongly held conviction within our profession to a shared goal that the Scottish Government has publicly committed to working with us to complete. A change supported with an inflation proofing commitment and ongoing negotiations that maintain the momentum of the campaign into next year.

Negotiations for the 2024/25 pay uplift will start a few months before the start of the next tax year and we are aware that what represents credible progress will be the point of contention between SJDC and the Scottish Government. SJDC will continue to measure the extent of our pay erosion in real terms using RPI, and we will be looking for the 8.8% pay increase above RPI that we need at each negotiation round to achieve full pay restoration within our five-year target.

Accepting this offer should not be seen as kicking the can down the road, rather it should be seen as structuring our next steps and sustainably increasing our leverage. Scottish junior doctors can bank a salary increase between £3,429 to £7,111 depending on grade, without having lost any pay to industrial action, whilst knowing SJDC will be re-entering direct pay negotiation with the Scottish Government within months.

If sufficient progress is not made from there, we will re-ballot for industrial action using the changed political framing this offer brings us. Our campaign will no longer advocate for a 35% rise but can request the yearly uplift of 8.8% above inflation needed to make credible progress to restore our pay to 2008 levels in real terms, a commitment the Scottish Government have now given in their own words.

It is important to consider that our leverage this year in Scotland was likely near its highest point just before taking industrial action, given the importance first minister Humza Yousaf placed on preventing industrial action within the healthcare sector during his recent leadership campaign.

Some have questioned why we are not taking industrial action now to seek a fixed percentage added on top of the inflationary minimum. First, any additional percentage on top of inflation that the Scottish Government could add within the current political and economic context would likely be too low to make credible progress towards full pay restoration.

Second, our membership will have taken sustained industrial action with little real progress on top of the existing offer to show for it and may be hesitant to engage with likely required re-balloting over the next few years. The fixed percentage may then represent the ceiling of what we will achieve rather than the floor for ongoing negotiations where we think genuine progress can be made.

We continue to learn from the successful trade unions across the world who normalise the process of balloting and taking industrial action to their members. Our action must be sustainable. As doctors employed in the public sector, we need to learn that it is consistent engagement with trade unionism that brings meaningful long-term improvements in terms and conditions of work.

The final part of the offer looks towards the future. By 2026, SJDC and the Scottish Government will both renegotiate the 2002 junior doctor contract and agree a new review mechanism for junior doctor pay with the combined aim of achieving ‘a mutually agreeable path to achieve pay restoration and preventing [pay] erosion recurring in the future’. Terms of reference for both negotiations will be agreed within the current ballot period.

Contract negotiation is well overdue in Scotland. Huge improvements in our terms and conditions of employment can be made and SJDC will begin a consultation process with members to determine our key priorities for the new contract over the coming months. Importantly, no preconditions have been set for these talks with the Scottish Government and the 2016 English junior contract will not be used as a template.

The new pay review mechanism will effectively withdraw Scottish junior doctors from the influence of the DDRB, the supposedly independent body governments have used to hide targeted erosion of doctors’ pay for the past 15 years, which, as one Conservative backbencher put it, UK Government ministers are able to ‘basically rig’. We are pleased that the Scottish Government has finally acknowledged that the DDRB is not fit for purpose and hope that concession aids the BMA consultants committee in its ongoing campaign for DDRB reform.

This offer leaves a lot of work for SJDC over the next few years but has the potential to transform the working lives of junior doctors in Scotland. It is our belief that accepting it is the best next move for Scottish doctors towards full pay restoration as it offers us the path forward that we need to continue making genuine progress in this fight in a Scottish context.

We will win with the continued determination and commitment of Scottish junior doctors who have shown over the past year that they are willing to fight. SJDC has worked relentlessly to get this far, and we will continue to do so.

Hugh Pearson is deputy chair of the BMA Scotland junior doctors committee. This article was first published on Medium.