The WSWS is publishing this Open Letter by a resident doctor to their colleagues addressing the issues in waging a successful struggle against the Starmer government. Sophie works at a London hospital and is active in NHS FightBack.

It draws a balance sheet of the three-year struggle waged by 50,000 members of the British Medical Association (BMA) in England for pay restoration and resolving the acute unemployment crisis facing resident doctors in the National Health Service (NHS).

NHS FightBack is encouraging a wide-ranging discussion by resident doctors and NHS staff across the UK.

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Dear Colleagues,

Despite unprecedented action by resident doctors—our latest six-day strike the longest yet—we are still no closer to pay restoration or securing specialty training posts to keep us in employment. This is not due to any lack of resistance from below. It is the result of a dead-end strategy pursued from above, by union leaders who isolate our struggle in closed-door negotiations with an unmoving Labour government.

We do not take industrial action lightly; we strike because the erosion of pay, the chronic shortage of training posts and collapsing staffing levels are causing real harm to our colleagues and patients, and threatening the NHS itself.

After fifteen strikes over three years, the facts remain unchanged:

Real terms pay has been cut by 21 percent since 2008.

There has been no meaningful rise in specialty training posts. Tens of thousands of doctors will remain jobless this year. Health Secretary Wes Streeting has taken away even the 4,500 repurposed jobs he offered over three years.

Working conditions have deteriorated: long hours, lack of breaks, and single-handedly covering the jobs of two or three doctors are routine.

So, why have over 50 days of strike action not delivered results? We must look to the strategy of our “leaders” in the British Medical Association (BMA). Our ranks have shown great strength despite threats and intimidation, including Labour Prime Minister Keir Starmer denouncing our action as “reckless” for opposing a 3.5 percent award—another pay cut over three years. Yet our leadership, the BMA Resident Doctors Committee (RDC), has only sought a settlement with the very government that attacks us so viciously.

When we came out in force with a 93 percent mandate for renewed strike action in the last ballot, RDC chair Jack Fletcher said they would continue talks in “good faith” and made clear they were not seeking full pay restoration “in one go, overnight.” When we demanded more specialty training jobs, he said the government’s offer of 4,500 repurposed posts and a divisive prioritisation bill was “progress”. Historically, when junior doctors fought against Jeremy Hunt’s 2016 contract that slashed pay and increased working hours, the BMA sold us out, calling it a “good deal.” They seek accommodation with the government, rather than waging a fight against it.

This offers only further betrayals in the face of a Starmer government that plans to increase cuts, force productivity, and expand the private sector. Streeting boasts that the service “maintained 95 percent of planned care” while we were on strike. In reality, it is only through our efforts and those of other NHS staff that the service is kept alive every day. It is our sweat and tears as we face unpaid overtime, unsafe staffing levels and exhaustion.

Streeting can only remove blame from the government, and scapegoat us, because the BMA does not defend us against his vile attacks that devalue our role. The BMA’s meagre responses do nothing to portray the depth of anger we feel in our everyday work.

Though we are thousands strong, the BMA has isolated our struggle. GPs overwhelmingly rejected the imposed 2026/27 contract with a 99 percent “No” vote, but the BMA has organised separate action for them in April. Consultants and specialist doctors have made the same complaints about pay and conditions, but they are not being balloted until May, closing in early July. Our colleagues in Wales, Scotland and Northern Ireland have all been involved in disputes, yet each has been fragmented and kept separate from united action.

Worst of all, the union leadership has not explained the link between all our disputes and the broader crisis of an NHS pushed to collapse. 7.2 million patients are on waiting lists; more than 1,700 wait at least 12 hours in emergency departments each day; and 23,000 people died last year due to long waits or overcrowding in A&E in England alone.

Staff shortages affect every profession, with an estimated shortfall of more than 100,000 staff projected to reach 250,000 by 2030. Yet the wider NHS workforce has been offered an insulting 3.3 percent pay rise this year. The union leadership has failed not only to explain but to organise around the fact that every dispute is inseparable from the crisis of a marketised system that starves healthcare of funds while channelling billions to private profiteers and military spending.

Some senior union officials have even launched a smear campaign against resident doctors, attempting to divide us from our colleagues. In a Guardian article they anonymously complained that we are asking for too much! This is only so they can justify sub-inflation deals for members of their own union. Their statements are indistinguishable from Streeting’s claim that we are “holding the country to ransom.”

Streeting has been emboldened to consider outlawing future industrial action by doctors. This blatant suppression of our right to strike must serve as a warning to all workers. Instead of condemning this threat, Jack Fletcher caved in, saying “we’re not going to call illegal [strike] action,” and that the union has always, “tried, and we continue to try, to talk to the Government without any industrial action.”

We cannot expect serious opposition from other trade union leaders. The Trades Union Congress did not organise a single day of strike action against the Minimum Service Levels Bill introduced by the Tories in 2023. Now the Labour government, having repealed it, openly discusses similar measures to be used against all NHS staff. Similarly, Dr. Rahmeh Aladwan, who has spoken out against the Gaza genocide, has been charged with terrorist and public order offences for defending the right of the Palestinians to self-defence, protected under international law—with no defence of her by the unions.

The union apparatus is bankrupt—it restricts our struggle and protects bureaucratic privilege. We cannot continue in this way. We on the frontline know the real conditions: unsafe wards, unpaid overtime and burnout. We have already shown our resistance. Now we must take responsibility for conducting this fight ourselves.

That means building our own rank-and-file committees, in opposition to a union leadership that kneels before a government preparing the burial of the NHS.

No amount of pressure will force an intransigent government to change course. These policies are rooted in the interests of the corporate and financial elite, prioritising billions for the ruling class over social need. The defence of universal, publicly funded healthcare cannot be achieved within capitalism. We must adopt a political perspective: independence from all parties that defend capitalist priorities, and an appeal to workers internationally facing the same attacks.

Our six-day strike demonstrated the scale of anger that exists. We need to break out of the control of the BMA bureaucracy and turn towards our colleagues. As 1.4 million NHS workers, we have the strength to unite and organise independently to defend the NHS—for all who work in it and rely on it.

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We encourage resident doctors and NHS workers to share this letter, send in your responses to the WSWS, and help open lines of communication to help expose how the NHS is being driven to the brink by the Starmer government. Your anonymity will be protected. Sign up to the NHS FightBack newsletter and take part in building a global rank-and-file movement of health workers against austerity and war to defend public health over profit.