As the UK's junior doctors go on strike for the 15th round of strikes at a cost of more than £3bn in over three years and with salaries up by 35%, the question National Health Service (NHS) managers are asking is whether the NHS could run efficiently without them, reports The Telegraph.
By the time they return to work next week, there will have been more than 60 days of walkouts in three years. It also hints at some questions: are the junior doctors – now rebranded as resident doctors after Health Secretary Wes Streeting agreed to adopt the title during negotiations – striking themselves out of jobs permanently; or should the system itself be reshaped and redesigned?
The government will no doubt point out that the salary terms rejected by the British Medical Association (BMA) would have left trainee medics 35% better off than four years ago. The union will doubtless argue again that the Iran war means this is insufficient, while ministers say that the same conflict makes the country’s finances even more precarious.
Meanwhile, the BMA’s own staff will take part in simultaneous walkouts, unsurprisingly aggrieved that they are being offered a far lower rise than the one rejected by medics.
But three years of strikes have taught those leading the NHS some lessons the union might rather they had not learned.
A number of hospital chief executives have remarked that during the last set of strikes by resident doctors, just before Christmas, the NHS ran far more smoothly than normal.
Several told The Telegraph that senior doctors standing in for juniors were more decisive in decisions on treatment and discharge, meaning patients were sent home more quickly.
Today, the model will be tested once more, with health officials aiming to go ahead with 95% of planned appointments and operations, as was the case in December.
And it is precisely this ability to cope that is prompting a more fundamental rethink.
Sir Jim Mackey, Head of the NHS, who anticipated a “long slog” of strikes over the next year, suggests that the NHS redesigns the way it works, with less reliance on resident doctors.
He asks: “How do you build [services] less reliant on a transient training workforce and on a more blended clinical family?”
If the service faced “a long period of strikes”, NHS England would “get more active” in this area, he told Health Service Journal, arguing it was necessary to create a system on which patients could actually rely.
He points to models abroad, and to his experience running Northumbria Healthcare trust, where efforts were made to reduce dependence on doctors in training.
It is an arresting idea: a health service that works better without its trainees. More decisive, more efficient, less encumbered by inexperience.
And yet, taken to its logical conclusion, it begins to feel faintly fantastical.
Medicine does not replenish itself. Every consultant once hesitated over their first discharge summary, first ward round, first night shift. The pipeline is not an optional extra; it is the system’s lifeblood.
To imagine a hospital without trainees is rather like imagining a university without students. It works beautifully on paper. In reality, it defeats the purpose.
And yet the frustration among senior leaders is real. What the strikes have exposed is not simply a dispute over pay, but a deeper unease about how the NHS is organised.
Resident doctors rotate frequently, often every few months, moving hospitals, teams and regions. For managers trying to run a stable service, this creates a workforce that can feel, in Sir Jim’s words, “transient”.
Older consultants, too, speak privately of a shift in culture. Today’s trainees can feel like itinerant workers, cycling through placements with little attachment to any one hospital. It is harder, in such a system, to foster continuity or long-term responsibility.
But if that is the diagnosis, the cure is far from straightforward.
Many doctors are in their 30s before they secure stable roles. They face years of exams, relocations and uncertain progression.
Outside the hospital, the economic reality bites just as hard. The sense of being perpetually in training, professionally and financially, is difficult to ignore.
At the same time, the NHS itself is changing. Advanced nurse practitioners, physician associates and other roles have expanded.
Technology, too, is beginning to reshape practice, with artificial intelligence edging into diagnostics, triage and administration, ready to take on a central role.
Some of this points towards a more senior, more specialised workforce, with fewer trainees doing routine tasks.
But there are limits. New roles can supplement, but they do not eliminate the need for doctors to learn by doing. A system that hollowed out its junior ranks too far would, in time, and itself short of experienced clinicians.
However, right now there is a major risk for the doctors themselves.
The more NHS leaders suggest that services can cope, or even improve, during strikes, the more they erode the claim that the workforce is indispensable.
This is the bind. Industrial action is meant to demonstrate value by withdrawal of labour. If the system adapts, the argument weakens.
Are resident doctors worth it? Certainly, no health system can function without training its future workforce. But that is not the same as saying they are irreplaceable in their current form, or that the system should bend to their demands, including pay rises which far exceed those of most taxpayers.
In the short term, the BMA is placing its members in a precarious position, at a moment when the NHS is already experimenting with ways to rely on them less.
A workforce that withdraws its labour repeatedly, while insisting on ever greater rewards, does not simply apply pressure. It invites the system to adapt around it.
And once that process begins, it is very hard to reverse.
The Telegraph article – Are junior doctors worth it? (Open access)
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