When Resident Doctors went on strike under the last Conservative government in 2023-2024, the politics were straightforward for social democrats. Doctors were striking as part of the biggest wave of industrial action since 1989, as workers across the economy responded to rampant inflation. The pay erosion doctors were facing was a direct result of government pay policy since the Coalition era, beginning with the 1% public sector cap introduced in 2010. Moreover, refusing to recognise industrial action as an intrinsic part of any functioning democracy, the government responded to the resident doctors strike by attempting to ban it using ‘minimum service’ legislation.
Today, the situation is different. The party in power is Labour, it is not undermining the right of doctors to withdraw their labour, and its basic negotiating position is far more reasonable than that of its predecessor. Consequently, reactionary elements of the pay dispute on the BMA’s side have become apparent, with the question now no longer ‘do doctors have the right to strike?’ (they do), but rather ‘why are they striking?’
The BMA argues that industrial action is the only way to secure pay awards that will repair years of real pay erosion (21% when calculated using RPI). Additionally, the BMA points to the shortage of available specialty training places which mean that many doctors face unemployment during their training, and will take longer to qualify to Consultant level.
Fundamentally however, this dispute is about maintaining the status of a middle-class profession in crisis. Unlike the pay erosion faced by many other kinds of workers, the pay erosion faced by doctors has not been experienced on an individual level (anyone who was a resident doctor 15 years ago, and most of the cohort will no longer be, is earning more in real terms now due to professional progression). What doctors are experiencing is thus less a drop in living standards than a drop in status, as earnings and career progression no longer match the standards and progression most doctors envisaged when they enrolled in medical school.
Many resident doctors feel that their earnings are not close enough to their peers who entered better remunerated professions (e.g. barristers) and too close to minimum wage jobs (see the advert the BMA placed in the Guardian in 2023). This sentiment often manifests in visibly ugly forms, such as the calls to limit the number of training places offered to foreign qualified doctors - essentially ‘British jobs for British doctors’ - regardless of comparative capability. It also lends itself towards more uncompromising positions, as shown by the often-febrile response to the use of Medical Associate Professionals (whose cheaper labour threatens to rob doctors of training opportunities).
In short, the BMA has - perhaps as a result of being led at the national level by shop-floor professionals - embraced a reactionary politics of salary differentials and protectionism, based on a desire to suppress the (relative) status of other workers.
This presents a challenge to social democrats. Industrial action cannot be supported just because it is industrial action (by that logic the Liverpool dockers who came out in support of Powell were a worthy cause of support). Industrial action, while an inalienable human right, is only ever a means to an end. The ends that social democrats should support include fair pay, decent treatment, and a more equal society in which workers are not subordinate to production. They do not include a defence of middle-class status self-consciously standing apart from the wider labour movement. Anyone thinking that successful industrial action from doctors’ will result in structural victories for other NHS staff (such as pay review bodies being abolished or by serving as inspiration for millitancy) is extremely naive.
This does not mean questioning the right to strike. Nor does it mean questioning the legitimacy of the BMA’s right to seek to advance the interests of its members (including at the expense of other workers). What it does mean, however, is that when confronted with a reactionary dispute, a social-democratic government should be unashamed and unafraid of identifying and criticising the class politics being expressed by such a strike, and of articulating its own reasoned position.
The current BMA strikes will burn out eventually: compared with the action two years ago, strike observance from doctors is less consistent, and ballot turnouts show that the strikes have not coincided with a spike in BMA membership (in September 2024 66,420 Resident Doctors were members of the BMA, in February 2026 that figure was 53,670). However, Labour’s response has also been inadequate. Not only has it failed to articulate a clear critique of the reactionary politics of the strikes, but much of the current conflict results from its failure to sufficiently honour the terms of its original post-election agreement to reform the terms and conditions of training places.
While it has not (yet) displayed the same public contempt for industrial relations that the previous government did, there are now concerning reports that it is considering banning doctors from striking. Should this be pursued, it would drastically alter the nature of this dispute, rendering the reactionary elements of the BMA’s position a secondary concern to an existential question of labour rights. In such circumstances, social democrats must be ready to defend the right to strike, regardless of the politics of the strikes themselves.
Sam Sachs is a labour movement activist and writer