Jeremy Hunt is to offer junior doctors an 11% rise in basic pay in a last-minute bid to stop them going on strike just as the NHS is preparing for its most pressured time of year.

The health secretary’s dramatic move – part of a package of new concessions he will announce on Wednesday – is intended to persuade England’s 45,000 trainee doctors, who are furious at his threat to impose a punitive new contract on them, to vote against strike action when their ballot begins on Thursday.



He is expected to stress that the offered 11% increase in basic pay is far more than the maximum 1% annual rises that public sector workers have been told to expect in the next few years. However, the proposed rise would neither cost nor save the NHS any money, sources say. Hunt pledged last week that no junior doctor would be worse off under the new contract.

Hunt’s intervention comes as the junior doctors committee of the British Medical Association (BMA), which represents most doctors, prepares to ballot its members about their willingness to take action, which would affect a wide range of NHS services, and lead to the cancellation of planned operations and outpatient clinics, most probably in the runup to Christmas.

Junior doctors heavily involved in the dispute and some senior doctors who lead medical royal colleges believe that without major concessions from Hunt as many as 80% or even 90% of trainee doctors – all those below consultant grade – will vote for strike action, industrial action short of a strike, or both.

However some junior doctors have already rejected Hunt’s offer. One, Milo Hollingsworth, a junior doctor who works in neurosurgery at the North Bristol NHS Trust, said: “The sugar coating is Hunt will increase base pay by 11% but the bitter pill is the cut on out-of-hours pay. This will result in a net loss of 20%-30% regardless of his token 11% increase in base pay. Furthermore, they will abolish incremental pay so we get paid lower rates for longer. He has conceded nothing.

“I am paid £27,000 base salary for working 8-5pm Monday to Friday. I am paid a further 50% for working nights, weekends and bank holidays. I have worked every bank holiday of 2015. These changes would see my base pay increased to £29,000 but my out-of-hours pay cut would leave me with a yearly income of £32,000 from next August; £8,000 less than this year.”

Thousands rallied in central London on Saturday 17 October following a move by Jeremy Hunt to alter junior doctors contracts Guardian

Another junior doctor pointed out that Hunt’s 11% offer is well below even the smallest pay rise – of 14.9% – that the Doctors and Dentists’ Review Body, which advises ministers, proposed that junior doctors should get in return for more of the antisocial hours they currently get extra pay for being reclassified as normal working time.

“If I didn’t understand what was going on, I would think that an 11% pay rise was a very generous concession. This isn’t the case. It isn’t only about the money, but by making this offer, Mr Hunt is trying to make it so. Our reasoning is based on patient safety. By removing the safeguards on [the total number of] hours [a trainee medic can be told to work], doctors will be working unsafe hours, leading to poor patient care.”



One source involved in helping to formulate Hunt’s new offer said it represented a serious move to break the impasse over the pay and conditions of NHS medics and is his “last-ditch attempt to resolve the junior doctors dispute” before the ballot produces a widely expected mandate for action.

If junior doctors do back a withdrawal of labour then the BMA plans that the first action will see trainees provide only emergency care, which would inconvenience thousands of patients and force consultants to cover their shifts. But the union has also warned that it could then hold an all-out strike – “a withdrawal of all junior doctors’ labour” – if Hunt does not undertake major U-turns on key issues.

Jeremy Hunt, the secretary for health, says he is disappointed with the behaviour of the BMA over the government’s proposed changes to junior doctors’ contracts which lead to mass protests in central London Guardian

Hunt hopes that the 11% uplift will persuade junior doctors to accept him scrapping the banding system, which dictates how much juniors are paid, depending on their responsibilities, hours worked and how often they are on call.

Banding currently gives junior doctors 40% to 50% more money on top of their basic salary. Hunt will argue that trainees will still be able to earn the same money as now, despite banding disappearing, by still receiving extra money from the on-call supplement, out-of-hours payments, “flexible pay premia” – financial inducements to persuade juniors to choose certain branches of medicine suffering from major shortages of doctors – additional rostered hours and the extra 11%.

In a further climbdown from his original position, Hunt will also retreat from his initial plan to extend the hours in which trainees get only basic rates to include all day Saturday from 7am to 10pm. One option could be that in future only Saturday morning will count as part of a junior doctor’s normal working week, for which they receive basic pay.

In a further concession the health secretary will also guarantee that flexible pay premia will be extended to more specialties than originally intended. Until now Hunt only promised that young doctors opting to specialise in general practice or A&E care would receive them.

But his new offer extends that to medics working in other areas of acute and emergency medicine in hospitals which involve regular on-call or out-of-hours work, such as those on acute medical wards, where many of the sickest patients end up after being admitted through A&E, and in psychiatry.

Hunt’s move appears to be a major effort to solve a dispute that prompted 20,000 junior doctors to stage a protest march through central London last month and has led to growing concern among Tory MPs about his handling of it.

But it is hard to predict if this latest offer will avert a walkout as he has also decided not to budge on several key issues which have roused junior doctors’ anger. For example, he still intends to significantly increase the hours in which junior doctors receive only basic pay from the existing 7pm on weekdays to 10pm. Junior doctors are likely to argue that such an extension would wipe out the value of an 11% pay rise as they would lose more money than they would gain because weekday evenings would no longer count as antisocial shifts, a system which bulks up the pay that many receive.

Hunt also plans to press ahead with removing what the BMA says is a vital safety net that prevents hospitals from forcing juniors to work excessive hours that could leave medics so tired that they pose a threat to patients.

He will try and assuage concern on that issue by giving the Care Quality Commission, the NHS regulator, new powers to ensure that juniors are not being overworked.

As recently as Sunday, Hunt tried to dissuade junior doctors from striking in a Sunday Telegraph article that asked them to pull back from the “barricades” and refuse to endorse action that would put patients’ safety at risk.

Sources involved in Hunt’s new offer say they hope it will defuse the fury at Hunt that is widespread among junior doctors and, even if it does not prevent industrial action, will help him by exacerbating private divisions within the BMA over whether or not to take industrial action. They also hope it will make him appear reasonable and conciliatory if a strike still goes ahead.

Dr Johann Malawana, the BMA junior doctors committee chair, said: “Junior doctors need facts, not piecemeal announcements and we need to see the full detail of this latest, eleventh hour offer to understand what, in reality, it will mean for junior doctors.

“The BMA and junior doctors have been clear that we want to reach a negotiated agreement with the government on a contract that is good for patients, junior doctors and the NHS. In order to do this we have said, repeatedly, that the government must remove the threat of imposition and provide the concrete assurances junior doctors have asked for on a contract that is safe and fair.

“We are clear that without the assurances we require, the BMA will be left with little option but to continue with our plans to ballot members.”