Intended for healthcare professionals


Why we need full pay restoration

BMJ 2022; 378 doi: (Published 11 August 2022) Cite this as: BMJ 2022;378:o2006
  1. Jo Sutton-Klein, junior doctor in emergency medicine, UK

The declining value of junior doctors' pay is being felt in every aspect of their lives, writes Jo Sutton-Klein

Doctors in the UK today are paid around 30% less than they were in 2008 after taking into account inflation measured by the retail price index.1 In medical speak, we might say that pay cuts have had an insidious onset. If we cast our minds back to 2008, we were in the middle of a global financial crisis. The now debunked myth that the crisis was caused by overspending from the government was used to justify subsequent pay freezes across the public sector.2 Although the pay freezes were lifted in the early 2010s, public sector workers in the UK have never seen their pay increase to match inflation.

Time to wake up to the pay cuts

The slow creep of the pay cuts made them a lot easier to swallow. Unless you were paying close attention to the British Medical Association (BMA) or other trade unions, you might not have even known that between 2008 and 2020 the real terms value of junior doctors’ salaries had already fallen by around 23%.3 However, now that inflation is at its highest rate in 40 years, the failure of our pay to keep pace with the cost of living has become starker and harder to ignore. With inflation hitting 11% and junior doctors’ pay increasing by just 2%, this year alone junior doctors’ real terms pay is down by 9%.4 Junior doctors are feeling the impact of these cuts in every aspect of our lives.

I was in the first cohort of students that had to pay £9000 a year in tuition fees. This, combined with the ongoing declining value of our pay, means that I will spend most of my working life living with debt that I may never finish paying off.5 Junior doctors in my generation are paying for professional exams on credit cards, delaying starting families, and skipping holidays altogether. Saving for a deposit for a mortgage now seems beyond the reach of many of us.

Where has all the money gone?

The government’s failure to match doctors’ salaries with the rising cost of living is not because they’ve instead prioritised pay for other NHS workers. Huge swathes of NHS staff, including porters, nurses, and midwives,6 have also faced large cuts to their real terms pay since 2008 and, like doctors, have been campaigning for pay restoration.7 Nor has the government shown such parsimony when it comes to spending money on other outgoings. In the past two years alone, eye watering sums of public money have been frittered away by the government, whether it’s the £4bn spent on wasted personal protective equipment,8 £29 billion on the failed Test and Trace programme,9 or millions given out in dubious contracts to their mates.1011

Over the past 15 years, while millions of workers across the UK have had real terms pay cuts, the number of billionaires in the UK has skyrocketed.12 Despite this, we’re already seeing spin that in order to fund pay rises for NHS workers, we will need to cut funding from cancer patients,13 with the government conveniently ignoring the obvious solution of progressive taxation. This attempt to pit patients against workers comes from a government that has presided over the exponential growth of NHS waiting lists,14 huge reductions in the number of hospital beds,15 and an escalating staffing crisis.16 They have steadfastly failed to tackle the challenges affecting patient care and the running of the NHS.

We’re (almost) all in this together

It is not just doctors who have faced huge real terms pay cuts over the past 15 years, nor is it just NHS workers. In the UK, workers across the public and private sector are on average worse off today than they were in 2008.17 The wave of industrial action across different public and private sectors is growing, with more and more workers coming together to collectively organise, bargain, and withdraw their labour in return for better pay. These workers are not just winning, but they’re winning big. In the past six months the tried and tested formula of traditional trade unionism has won Gatwick airport workers a 21% pay rise,18 bin workers in Manchester a 22% pay rise,19 and cleaners and porters in Croydon hospital a 24% pay rise.20

Trade unionism is infectiously inspiring. When workers in one workplace win, workers in other workplaces, who have seen the power of collective organisation, unionise and win. Doctors are not the worst paid staff in the NHS, but rather than being a reason to hesitate in our demand for a full pay restoration, this is yet another reason to grow the campaign. Doctors are one of the most powerful groups of workers in the NHS: if doctors win full pay restoration, we lay the path for others to follow.

At a doctors pay restoration protest last month, doctors heard speeches from a nurse, occupational therapist, and tube driver. While NHS hospitals have been opening food banks and advertising salary advance schemes to their struggling staff,2122 workers themselves have a simpler solution: full pay restoration for all.


  • Competing interests: I have read and understood The BMJ policy on declaration of interests and declare the following interests: none.

  • Provenance and peer review: commissioned; not externally peer reviewed.


View Abstract