The British Medical Association has just shown its contempt for science
The British Medical Association hasn't gone out of its way to court public affection lately – the 11 strikes the BMA has held since 2022 resulted in about 1.5 million cancelled appointments, though they also resulted in an astonishing increase in its members' pay. And it's a safe bet that patients won't be edified to learn that they're now 'energised' at the prospect of yet another strike.
But if the doctors' union is disastrously out of touch on strikes, it turns out that it's even more remote from public opinion on the contentious trans issue. The Cass Review recommended an almost complete ban on puberty blockers for children. Well, the man who led the BMA's opposition to the Report, Tom Dolphin, has now been made chairman of the BMA's council, its governing body.
The appointment followed what looks like a coup by the 69 member board which ousted the previous incumbent, Professor Philip Banfield. Dr Dolphin tabled an emergency motion last July that led to the union rejecting the Cass report. It announced it would be publishing its own review instead. But alas, nothing has so far appeared.
Let's remember that Hilary Cass, the author of the report, found that 'there is no good evidence' that puberty blockers for young people are safe to use and that 'it is unusual for us to give a potentially life-changing treatment to young people and not know what happens to them in adulthood'.
And it seems that in fact many doctors agreed. When the BMA council bypassed debate to reject the Cass review after it ran out of time to discuss the motion at the annual meeting, there were four attempts by members to have an open debate on the review. More than 1,500 doctors, the majority of them BMA members, signed a 'Not in Our Name' open letter to the BMA council, criticising the 'very undemocratic' decision to reject Lady Cass's findings.
But rather than respond to members' concerns, the BMA council has now elected Tom Dolphin to lead the organisation. It's not out to please, is it? Dr Dolphin's view on this issue can be judged by his position three years ago, when he posted photos of himself getting ready for a Trans Pride march, saying: 'About to set off to let London know that trans rights are human rights!'
Mind you, he didn't focus on this when he accepted his new position, observing that the last three years 'has been a period of huge change for the BMA which has seen doctors realise the power that they have as trade union members to change their working lives … for the better. The fight to restore doctors' pay and pensions continues.' More militancy then.
You have to ask: are doctors really best led by a man who takes such a radical approach to giving life-altering drugs to children confused about their gender? I'd say it's proof that the BMA isn't an organisation that patients or the Government can take seriously.
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He has stuck with it ever since, including 20 years as chief executive of Northumbria Healthcare NHS foundation trust from 2003 to 2023. The hospital trust became the most successful in the country, with by far the highest ratings, in what watchdogs described as a 'remarkable' first for the NHS. It also embarked on radical reforms, taking over community and GP services, in a model of integrated care that next week's plan will encourage the best foundation trusts to follow. But when asked how the NHS needs to change in order to deliver for patients, Sir Jim's story becomes much more personal; about how his own family's experience at the hands of the NHS, and the failure of the service to listen to its patients has driven him. 'My dad died in a hospital where the local folklore was terrible about the hospital, but the hospital was deaf to it and didn't know what was actually being said. 'I wasn't long into the NHS, it was a long time ago now, and I felt really powerless. 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Sir Jim seems visibly appalled by the bureaucratic empire the NHS has created. 'Most NHS organisations are massive,' he said: 'It's hard for people outside the NHS to get their head around.' NHS England, which has 13,500 staff, and the Department of Health and Social Care, with more than 4,000 staff, will see numbers halved. So too will 42 integrated care boards, which employ around 25,000 people. 'We definitely got very complicated and very expensive in our operating model, our corporate overhead,' he said, with far too many layers of oversight. 'It takes forever. It costs a fortune. We need to 'delayer it' because it's expensive, it slows decision-making down, it de-powers people who need to make decisions and need the service to move more quickly and more in a more agile fashion.' He described deep frustrations as a hospital trust chief executive at the sharp end of it, recalling thinking: 'I just don't know how to get that decision made any more.' Public confidence in the NHS has slumped to rock bottom since the pandemic, with just 21 per cent of people expressing satisfaction last year. However, Sir Jim said the health service was heading into trouble long before. 'We ran into Covid in bad shape. All of the key metrics are telling us we're in trouble, patient and staff experience, performance, statistics, financial position, going into Covid. We had that huge amount of public support in that first period. Then if we're honest, that disconnect with the population has just grown and grown.' He believes the goodwill of the public was squandered, suggesting that the NHS took it for granted. Failing to listen to public frustrations could mean the end of a national health service, he warned. In particular he highlighted maternity failings – where a national investigation is about to start. He said: 'I think it's behavioural, I think it's cultural. I think it's about how we listen to people and not desensitising; not thinking we know best when mothers know best – listening to them and families and building the service around them. 'The big worry is, if we don't grab that, and we don't deal with it with pace, we'll lose the population. If we lose the population, we've lost the NHS. For me, it's straightforward. The two things are completely dependent on each other.' Dwindling confidence in the NHS has been fuelled by worse access to services through the pandemic, and too slow a recovery since, allowing waiting lists to grow, he suggested. Swathes of activity were stopped during the pandemic, with more surgery stopped than in almost any European nation. 'Really difficult game' Sir Jim was on calls with healthcare chief executives across Europe and the United States at the time, and was well aware that other systems had paused far less activity – and sprang back much more quickly. 'We curtailed access much longer than other systems. So we were building up more of a problem than others were. There were a lot of other developed systems that were more agile and opened up more discerningly than we did. 'A lot of us operationally felt that we had people chomping at the bit, we knew we could do it safely but we couldn't in the circumstance… it was well-motivated, but we created more of a problem at that point.' Even in 2021, by now on secondment as NHS England's elective adviser, Sir Jim felt that hospitals were playing 'a really difficult game' with far reduced capacity, thanks to infection control practices brought in during the first lockdown, which were still in place some 18 months later. By 2022 the NHS was heading into strikes, with junior doctors, consultants and nurses all joining industrial action. Perhaps little surprise then, that productivity has tanked, despite record funding, with a sharp fall in the number of patients per medic in clinics and theatre lists. Last autumn, an investigation of the NHS by Lord Ara Darzi found that while hospital staff numbers had risen by 17 per cent since 2019, productivity was at least 11.4 per cent lower. 'There's a straightforward argument on productivity and recovery that says, whatever the reasons are, we're actually not seeing as many patients as we were then.' 'Fossilised' ways of working He goes on to suggest that the latest generation of medics may not be used to the workload that came before the pandemic: 'There's a lot of clinicians now who've only worked in a post-Covid environment... they never experienced the busy consulting in 2017 when we had 30 per cent more people on the list than we do now. That's a harder thing to change, because that's what they've come into… it's hard when you've got a big backlog.' However, Sir Jim suggested it was not just about speeding up; but rather about bringing an end to outdated practices. He warned that the NHS has too many 'fossilised' ways of working, some of which have barely moved on since 1948. Sir Jim said getting care out of hospitals into local neighbourhood centres is crucial, in order to tackle waste, and make care more convenient. 'There's so much to go at. There's so much to change in a short space of time.' Top of his list is reform of hospital appointments, which see millions of people routinely called back for checks that very few need. 'Outpatients is glaringly obvious. Of 130 million outpatients a year, about 85 million or so are follow-ups,' he said, saying it feels 'wrong' that the NHS diverts so much resource to follow-ups, at the expense of those waiting for diagnosis and treatment. The NHS spends more on hospital outpatients than on the whole of the GP primary care system, he said. Revamped NHS app The 10-year plan will pledge an overhaul of such systems, giving patients more direct access to medical teams, so they can seek help when it is needed, instead of being repeatedly summoned. A massively revamped NHS app will be key to 'liberating' the patient, Mr Streeting has said, giving a new front door to the health service, with AI used to direct patients to the right care, and users able to compare hospitals by outcomes, waiting times and patient satisfaction. Under the plans, the app will also be a route to contact medical teams and book appointments. It's a revolution Sir Jim has long been calling for, back in 2021, when appointed elective adviser to NHS England, warning of too many 'pointless' appointments. However, he is well aware that access needs to be just as good for those who cannot rely on digital access, including some of the most elderly and vulnerable. Reforming the system means bringing far more services together, out of hospitals, in settings close to home, with multiple checks offered simultaneously. Too many people are coming in and out of hospital for multiple interactions, often in the same week, forcing people to take a day off work and then do it all over again, just because 'we can't join the dots and do it in one go', he said. 'Too many people dying in hospital' The NHS fails to respect what patients actually want, he suggested; then ends up paying a higher bill for it, with long stays and multiple interventions. The simplest example is perhaps the most stark: 'We've got too many people dying in hospital when they want to die at home,' he said. The plan will put a central focus on the experience of patients, he promised. 'Patient power payments' will be trialled in some areas, with hospitals only getting the full tariff payment for their treatment if the patient was satisfied. When Mr Streeting unveils the final draft of the 10-year plan next week, it will have gone through so many drafts that those involved blush. Sir Jim said he was 'genuinely a bit emotional' on reading the first draft. 'I was thinking, thank God, we are talking about things I really want to talk about.' He praised its long-term ambition, saying the NHS has previously failed to look sufficiently ahead. Labour's election issue While the spending review is for three years, with a four-year plan for capital, it will look much further. 'One of our failures, I think, in the last sort of 10 years or so, has been our inability to think and plan ahead. But it generates some ambition. So you will look at it and think, 'Oh, that looks a bit frisky compared to where we are now'. That's the point. It's not saying this is all going to happen tomorrow.' For Labour, saving the NHS is an election issue. Sir Keir has pledged to restore the maximum wait to 18 weeks (for 92 per cent of cases) by the next election. Does Sir Jim feel like the next election result is resting on him? 'I don't worry about that,' he said, while he insisted the waiting pledge will be delivered. 'I worry about the population. I'm really competitive. I want to deliver on everything, and in all of that, I want to deliver for the population and our staff. I want to see more pride in the NHS; I want to see more joy. I want to see more celebration of the brilliance of it all; but we've got a lot to sort out.' That competitiveness isn't just professional. Sir Jim is a former competitive swimmer, who admitted to being 'a bit obsessive' about health and fitness, and said exercise was his first call if he is getting stressed. Carping from the sidelines One thing that frustrates him is critics carping from the sidelines, even before the plan is out. 'I needed to swim last night because I was wound up,' he said. 'I'm a very motivated person, right? Some would say I'm really driven, but I want to deliver. I feel the responsibility of delivering. And there's one thing about negativity that really winds me up is that kind of tone, that negativity, defeatism and cynicism when the plan isn't even locked down yet.' Another thing that wound him up? An article in the Daily Mail in April, which dubbed him 'Sleepy Jim' after catching him snoozing on the train back up to Newcastle. 'It did irritate us,' he said. 'The day before, I worked 17 or 18 hours, even on the day of that picture. I started at five. I finished it just after seven. I've been in a health select committee for two hours in the middle.' He was inundated with messages, unanimous in stating that the piece was 'a bloody disgrace'. 'Everybody who knows me knows I'm not sleepy, I'm not lazy. It jars, it was upsetting what it did to the family; one thing I'm not is sleepy.' He's up at 5am every day ('I was a swimmer, my kids were swimmers, my body clock has been completely buggered up since then'); when he can, he tries to get home at a decent time to see his family. 'Heart has always been in North East' Even when he took the top job, Sir Jim, a family man with a wife, two grown children and grandchildren, said 'my heart has always been in the North East'. He intends to return to Newcastle upon Tyne Hospitals NHS foundation trust, where he last year became chief executive, once he has 'led the NHS through its transition from the current crisis to getting back on its feet'. Football also keeps him going; he has previously described himself as a 'Newcastle United supporter with all the psychological scars'. Is he the Eddie Howe of the NHS, able to turn around the NHS, as much as 'Steady Eddie' has transformed Newcastle United's fortunes? He pauses – in a notably steady way: 'The Eddie Howe of the NHS?… He's very grounded and very analytical, a decent bloke, with a good way of getting the best out of people… I think there are some commonalities.'
The Independent
an hour ago
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Fact check: How much do resident doctors earn, and what do they want?
This roundup of claims has been compiled by Full Fact, the UK's largest fact checking charity working to find, expose and counter the harms of bad information. In May, the Government accepted recommendations from the Review Body on Doctors' and Dentists' Remuneration to give resident doctors (previously called 'junior' doctors) a pay rise of 4% plus £750. But the British Medical Association (BMA) says this is not enough to make up for the 'erosion' in the value of their pay that it says has happened since 2008. It is therefore balloting resident doctors about whether to strike. This fact check looks at what NHS resident doctors in England earn and what the BMA is asking for, and explores some of the claims currently circulating about their pay. Doctors have just been awarded a pay rise, so why are they threatening to strike? The BMA argues that the value of resident doctors' pay has been eroded by inflation since 2008/09, and it has published hourly pay figures showing what the pay 'restoration' it is asking for would look like. These pay figures amount to a 29% rise on the basic rates from 2024/25, instead of the 5-6% pay rise the Government announced. The Government, by contrast, says resident doctors have received the highest pay rise in the public sector for 2025/26, and that it expects average full-time basic pay for a resident doctor to reach about £54,300 in 2025/26 following the new deal. What resident doctors currently earn In the latest data for February 2025, there were 77,287 resident doctors working for NHS England. (Although a few are part-time, making this the equivalent of 74,666 full-time doctors.) These are working, qualified doctors who are also in the process of training towards a specialty, which can take a decade or more. They do not include consultants, GPs, surgeons or other senior doctors who have completed their specialist training. Resident doctors begin work after graduating with a medical degree. They are supervised by a more senior doctor, but as they gain experience some may also begin to supervise their more junior colleagues. Resident doctors need to pass exams at various points. In short, there are many different types of resident doctor, with different levels of seniority and pay. When speaking about basic pay only, for a 40-hour week, resident doctors currently earn between £38,831 and £73,992 a year, as recommended by the pay review body in May. At the time of writing however, they are still being paid at last year's rates while they wait for the new level to be applied. The Government has said they will receive the extra money, backdated to April, in August, at which point their actual pay will shift to the higher rate. The new rate amounts to a rise of about 5-6% on last year, depending on a doctor's pay grade, with the higher grades receiving slightly smaller rises in percentage terms. What about extra earnings? Basic pay does not cover everything that resident doctors earn. In the latest data for staff earnings, which covers the year ending March 2025, NHS England estimates how much different types of medical staff earned in that period. In practice, resident doctors typically earn almost a third more than their basic salary from other sources. Most of the extra pay comes from working extra hours and working unsocial hours, but it also includes geographic differences and other considerations. So does the average resident doctor now earn £54,300, as the Government says? The Government says: 'We expect the average full-time basic pay of a resident doctor will reach about £54,300 in 2025-26.' We asked the Department of Health and Social Care how this figure was calculated, and it shared its method with us. We were not able to replicate its calculations exactly, but we do know there are more resident doctors on the higher pay grades than on the lower ones, so an average in the higher part of the range seems plausible. According to NHS England workforce figures for February 2025, the resident doctor workforce breaks down as follows: – Foundation Doctor Year 1: 8,265 doctors, 11% of the total – Foundation Doctor Year 2: 7,394 doctors, 10% of the total – Core Training: 24,839 doctors, 32% of the total – Specialty Registrar: 36,789 doctors, 48% of the total It is difficult to say precisely how much the average resident doctor earns, because we can't exactly match the pay data we have to the numbers in each pay grade – and the latest NHS estimates cover earnings in the year to December 2024, before the latest pay rise was announced. Do resident doctors really earn £17/hour, as claimed by some? We've seen some claims on social media about resident doctors being paid £17 an hour. For example, one post on X which was shared by the BMA said: '£17/hr to save your life. That's the reality for NHS resident doctors in England'. This is potentially misleading, as the £17 figure seems to refer to the hourly rate of £17.56 cited by the BMA, which refers to basic pay only, for first-year doctors only, and for the last pay deal before the 2025/26 rise was announced – and the figure should in any case be £18, if rounding to the nearest pound. After the backdated pay rise, the BMA says the lowest hourly rate of basic pay will be £18.62. Full Fact has written in the past about claims which may appear to be about the pay of junior doctors in general, but are based on figures that apply only to the minority of them who are in their first year (about 11%). A BMA spokesperson told us: 'BMA publishes clear hourly rates which clearly show £17.56 as the wage per hour earned by a FY1 doctor in England. This is a fair comparison for use against other 40-hour per week jobs. FY1 doctors work on teams that save people's lives daily in the NHS. Their basic rate of pay is not affected by additional hours they might take on.'
