Hot Topic: Pay restoration and OMFS
The dispute over junior doctor pay in England continues to escalate in 2026, with proposed ongoing strike action between the 7-13 of April following the rejection of the government’s most recent pay offer. At the heart of the disagreement is the concept of “pay restoration” a demand to reverse the real-time decline in doctor salaries since 2008.
The BMA argues that, when adjusted for inflation, pay has fallen by roughly 25–26% over the past 15–17 years. This means that although salaries may have increased in cash terms, they have not kept up with the rising cost of living. They are therefore calling for a pay uplift of approximately 26% to restore earnings to their 2008 real-terms value.
To understand what this means in practice, consider current salary ranges. An FY1 in England typically earns around £32,000 per year. A 26% increase would raise this to approximately £40,300 and for a more experienced junior doctor earning £43,000, pay restoration would bring their salary to roughly £54,200. At the higher end, a senior registrar earning around £63,000 would see their pay rise to approximately £79,400 but with many doctors struggling to secure training posts they statistically are not likely to see the higher end and work with the range of £37,000-£45,000 working in SHO posts for years following their 7 years of diligent training.
In contrast, the government’s latest offer included a pay rise estimated at around 3.5% to 7%, alongside structural changes such as more frequent pay progression, expanded training posts, and coverage of certain professional costs like exam fees. While these measures were presented as a comprehensive package, the BMA rejected the proposal and since the government have leveraged the proposal to entice an ultimatum.
The primary reason for rejection is that the headline pay increase falls significantly short of the 26% restoration target. The main argument is that accepting a below-inflation rise would effectively cement the long-term pay cut they have experienced. Additionally, parts of the proposed increase were to be spread over multiple years, raising concerns that inflation could further erode the value over time.
There is also dissatisfaction with the focus on non-salary benefits. While changes to training pathways and reimbursement of expenses are welcomed, many doctors feel these do not address the core issue of basic pay. The dispute is therefore not just about immediate earnings, but about establishing a sustainable and competitive salary structure for the future. The discussion probes the question: what is the government’s long-term goal for the NHS? Are they looking to establish a functional system or merely temporarily quieten an overworked and undervalued workforce.
Wider workforce concerns are also central to the debate. Doctors point to increasing numbers leaving the NHS or moving abroad, citing pay as a major factor. They argue that without meaningful pay restoration, recruitment and retention will continue to suffer, placing further strain on the health service.
As it currently stands, with over 100,000 vacancies, doctors are often regularly required to work beyond scheduled hours risking patient care and their personal well-being. With training bottlenecks and an increasing workload the discussion of pay restoration covers more than just matching financial demands- if doctors are not able to progress in their careers to higher posts is it fair that they remain on a pay that doesn’t allow them opportunity to feel valued for the years of sacrifice they put in for the field ?
The government, however, maintains that recent pay awards already represent substantial increases and argues that meeting the full 26% demand would be financially unsustainable but this distorts the reality that the proposed 3.5% would be implemented over the coming years likely meaning that the pay-rise will still not cope with cost-living demands.
Ultimately, the dispute reflects a fundamental disagreement over how pay should be measured and what constitutes fairness. Until a compromise is reached, further industrial action remains likely, with both sides holding firm on their positions.
by Theresa Magobo
