The headlines the last couple weeks are familiar – and rarely flattering:

We will not ‘be held to ransom’ by striking doctors, says minister -BBC

Wes Streeting blasts doctors’ strike as ‘slap in the face’ for NHS -The Independent

From 14th to 19th November 2025, resident* (formerly “junior”) doctors across England will walk out again – the 13th round of industrial action since 2023 in a dispute that refuses to die down.

We all know that “full pay restoration” has been at the heart of these strikes in recent years. While the strikes this time are also about the growing crisis in training and career progression (and you can read more in this article here), today we’ll focus purely on pay and what the numbers tell us.

Both the government and the BMA insist that numbers are on their side.

So how do we know who’s right?

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*Resident doctor = refers to doctors from when they first qualify (at “FY1” level), up to senior registrars before they become consultants.

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Contents

1. What’s the Real Issue?
2. What the BMA Is Saying
   • The Maths in Brief
3. Why Doctors Say a 26% “Restoration” Is Needed
4. What the Government Is Saying
5. Does the Government Factor In Inflation?
   • CPI Calculation
6. CPI vs RPI – Why It Matters
7. The New Offer – and the BMA’s Response
8. The Bigger Picture
9. Conclusion: A Question of Value

What’s the Real Issue?

The government says it has offered doctors a 28.9% pay rise over three years, higher than most other public-sector uplifts.

The BMA says doctors have faced a 21% real-terms pay cut since 2008.

Both are technically correct – because they’re measuring different things:

• The government uses Consumer Price Index (CPI), which excludes housing costs and typically reports lower inflation*.
• The BMA uses Retail Price Index (RPI) which includes housing and mortgage interest – and tends to show higher inflation as a result.

Let’s unpack how each side reaches its figure.

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*Inflation = measure of how much prices of goods and services have gone up over time, so the same money buys less than it used to.

Inflation example:

If a loaf of bread cost £1 last year and prices rise by 10%, that same loaf now costs £1.10. Your £1 doesn’t stretch as far – that’s inflation in action.

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What the BMA Is Saying

“The BMA calculations show that pay awards for resident doctors in England from 2008/09 to 2025/26 have delivered a real-terms pay cut of 21%.”

–BMA

The BMA compared how doctors’ pay has kept up with the cost of living since 2008 using RPI  as the measure of inflation.

The BMA created a Pay Index, starting at 100 in 2008/09, tracking pay growth in cash terms. They then compared this to the RPI Index, published by the Office for National Statistics (ONS), which tracks price increases.

Key comparisons from their data: (all figures taken from BMA)

Year	Pay index	RPI index (taken from ONS)	Real-terms pay (%)
2008/09	100	211.5	0
2021/22	116.9	334.6	-26.1
2022/23	120.4	372.8	-31.7
2024/25	147.2	402.2	-22.6
2025/26	155.2	415.1	-20.9

By 2025/26, the real value of pay has fallen by around 21% – meaning doctors can buy 21% less with their salary than they could in 2008.

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The Maths in Brief

So, when we compare the 2008/09 indexes to 2025/26, this means:

So if Rn in 2008/09 is 100 (as this is the starting point, where pay is taken to be 100%), and Rn in 2025/26 is 79.18%, then:

• That is a fall of 100 − 79.13 = 20.87%
• This rounds to -20.9% real-terms pay erosion

Does this make more sense?

Why Doctors Say a 26% “Restoration” Is Needed

Percentages work off the current value, not the old one.

If pay drops from £100 to £79, a 20.9% pay rise only gets you to £95.51, not back to £100.

This is because any future pay increases are added to the £79, not the £100.

To get back to £100, you’d need roughly a 26% pay rise. That’s where the BMA’s ‘full pay restoration’ figure comes from.

What the Government Is Saying

“Resident doctors pay has increased by 28.9% across the last three years, thanks to this government. 

-Department of Health and Social Care

The government highlights three consecutive years of above-inflation increases:

Year	Pay Award	Details
2023/24	Around 13.2%	6% pay rise + £1,250 lump sum, + further 4.05% pay increase backdated to April 2023
2024/25	Around 8%	6% pay rise + £1,000 consolidated payment (an amount that gets added onto your salary permanently)
2025/26	Around 5.4%	4% pay rise + £750 consolidated payment

Add the pay award %’s up and you get the government’s 28.9% increase.

In nominal terms (the number on your payslip), an FY1 doctor earning £29,384 in 2021 now earns £38,831. But that doesn’t tell us what those pounds can buy.

Does the Government Factor In Inflation?

Yes – but it uses CPI, not RPI.

From the government’s perspective, resident doctor pay has outpaced inflation, meaning doctors are better off in real terms. For example:

• In 2023/24, pay rose 13.2% on average
• CPI inflation in that year (approx.) – 4%
• Pay increased more than inflation

Let’s test that using official inflation data.

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That’s a fall of 100 – 0.94.3 = 5.7.

So on the government’s preferred measure, doctors’ pay is down ~5.7% (rounded to 6%) in real terms, not 21%.

That’s a dramatic difference – and it all hinges on which inflation measure you use.

CPI vs RPI – Why It Matters

Retail Price Index (RPI) was the UK’s official inflation measure from 1956, but it began to be replaced by the Consumer Price Index (CPI) from the early 2000s and will be fully replaced by CPIH* in 2030.

However, different measures of inflation are still used for different purposes – by both government and private companies. Generally the measure chosen is the one that most benefits the user.

• Government income items such as tobacco and alcohol duty, rail fares, and even student loan interest rates are still linked to RPI, which produces higher inflation rate and therefore more revenue.
• Government expenditure items such as state pensions, benefits, and public-sector pay are linked to CPI, which show lower inflation and therefore smaller annual increases.

For doctors, that difference hits twice:

1. Their student loan interest rises with RPI,
2. but their pay awards are adjusted by CPI.

The result? Their debt grows faster than their wages – even before inflation eats into their pay. With student debts as high as £100,000 after 5+ years of study, it’s understandable why the BMA relies on RPI in its calculations.

The New Offer – and the BMA’s Response

In early November, Health Secretary Wes Streeting announced an updated offer:

• Coverage of exam and royal college fees.
• 1,000 specialty training places over the next three years (on top of 1,000 promised in the NHS 10-year plan).

The BMA rejected the offer.

This does not go far enough. Even with this offer, thousands of doctors would still be unable to find a job. 30,000 doctors applied for 10,000 places this year. 1,000 more is not going to fix this crisis, nor come anywhere near doing so. Whatever else is true of this offer, Mr Streeting is still not facing up to the gravity of the situation: doctors facing unemployment while patients can’t see a doctor.

We have also been clear with Government that they can call off strikes for years if they’re willing to offer a multi-year pay deal that restores pay over time.

–Dr Jack Fletcher, chair of the BMA’s resident doctor committee

The Bigger Picture

Even as resident doctors fight for restoration, pay disparities persist across doctors at all grades.

A GP trainee (ST3) can earn more per clinical session than a qualified salaried GP in England, simply because trainees are paid for protected learning time, while salaried GPs routinely work at least 5-10 unpaid hours a week.

• Qualified GP base salary: £76,038
• GPST3 (GP Registrar in their 3rd and final year) salary: £76,166 (basic salary + GP pay premium)

Meanwhile, consultant pay has lagged far behind comparable professions. A BMA analysis (June 2024) found that consultant pay in England rose by 14% between 2008 and 2022/23, compared to 48% for the average UK worker and nearly 80% for professions such as law, accountancy, architecture, engineering, and finance.

This isn’t unique to doctors, either. The Royal College of Nurses reports that starting salaries for nursing staff are more than £8,000 lower than they would be if pay had kept up with inflation since 2010.

Across the wider public sector, wages have broadly stagnated since 2011: an IFS report found that public-sector pay at the end of 2023 was still 1% lower than in 2007, while private-sector pay rose 4%.

This context matters. While doctors’ pay disputes attract headlines, they sit within a much broader pattern of public-sector wage stagnation and fragmented reform. The government’s piecemeal approach – offering separate pay deals for each group – only deepens the divide and resentment within the workforce.

With this in mind, and with resident doctors having received the largest pay awards in the sector two years in a row, you can understand why public opinion is mixed.

Conclusion: A Question of Value

Both sides of this dispute can back up their claims.

The BMA is right that doctors’ real pay has fallen if you use RPI.
The government is right that it has broadly kept pace with CPI given the pay awards of recent years.

But beyond the maths lies a deeper question:

Should public-sector pay simply track inflation, or should it reflect the professional and social value of the work itself?

Though this is only part of the picture. What about the growing crisis in training and career progression – the bottleneck that’s leaving thousands of doctors without jobs?

That’s a question worth exploring next.

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Editor’s note: This is a complex and often emotional topic. My aim here is to inform, not inflame – and to encourage fair, open discussion. If you have thoughts or experiences to share, I’d love to hear them – but please keep comments respectful of differing views.