NHS industrial action in England (2022-2024)

This publication, last updated in winter 2024, covered NHS industrial action in 2022-2024 and should be read as correct at the time of the last update.

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

There are currently no national strikes planned for Autumn/Winter 2024. However, some professions are taking part in other forms of industrial action. Further details are below.

Most NHS staff, including nurses, paramedics and some non-clinical staff, are paid on a scale called Agenda for Change (AfC). 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 had 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. In October 2024, the British Medical Association’s (BMA) General Practitioners committee for England published a vision for general practice that asks for an additional 11p per patient per day for essential services in 2025/26.

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”.

Resident doctors (formerly junior doctors)

There are no resident doctor strikes currently planned. In September 2024, junior doctors changed their name to resident doctors.

Resident doctors voted to accept a pay offer from government in September 2024, bringing an end to industrial action for this group. Resident doctors started taking periods of strike action in March 2023.

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 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.

In September 2024, RCN members in England voted to reject the 2024/25 pay award, but this was not a vote on industrial action.

Members of Unite are continuing to take strike action at some trusts in England over pay and 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.

2025/26 pay round

The government has published its remit letter to the Review Body on Doctors' and Dentists' Remuneration (DDRB): 2025 to 2026 and its remit letter to the NHS Pay Review Body (NHSPRB): 2025 to 2026. These letters ask the review bodies to make recommendations on NHS pay for 2025/26. The letters say that the Department of Health and Social Care will provide evidence to the bodies on recruitment and retention and funds available as soon as possible following the Autumn Budget on 30 October 2024.

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 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 resident 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 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.

Members of most AfC unions have voted to accept the award in consultations, including Unite and Unison.

RCN members in England voted to reject the 2024/25 pay award. This was not a vote on taking industrial action.

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. Resident doctors would receive a consolidated pay uplift of 6% plus £1,250. Following negotiations with the government, the following agreements were reached.

Resident Doctors

Resident doctor members of the BMA in England voted to accept a pay offer from the government in September 2024. The offer included 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 included 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 was on top of the previous 6% uplift for 2023/24 and separate to a 2024/25 pay award. The pay elements would be backdated to 1 March 2024. In addition, it was agreed that reforms to the DDRB would be in place for the 2025/26 pay round.

SAS doctors

The revised pay offer accepted by SAS doctors in June 2024 included 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 would be backdated to April 2024. The 2024/25 award 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 included a one-off payment for 2022/23 and a pay uplift for 2023/24. This wasbroken 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.