The Strike vs Training conundrum

The latest Resident Doctors Strike starts on Tuesday April 7th and is scheduled to last 6 days. Prime Minister Starmer’s reaction to the announcement was to issue an ultimatum to the BMA to call off the six-day strike, or it would withdraw an offer to create 1,000 extra specialty training places that were due to go live in April.

When the BMA rejected the latest pay offer and refused to cancel the strike, the government officially cancelled the new training posts. They argued that because the NHS must now prepare for strike disruption, it is no longer "operationally or financially possible" to launch and recruit for these new posts. 

Training posts are part of the dispute

On the face of it, there isn’t an obvious link between the Resident Doctors strike and training posts. However, these extra posts were not just a "sweetener" for Resident Doctors, but were a core part of the dispute itself.

Although salaries have fallen well behind virtually other sector in recent years, the strike is about training at least as much as it is about pay. Resident Doctors highlight a lack of specialty training posts - in 2025, there were 30,000 applicants for only 10,000 jobs. This gap leads to career stagnation, with many Residents having to settle for short-term "locally employed" roles with little training or financial security.

Resident Doctors no longer see a clear path to career progression, either in Hospital or General Practice. Access to training posts would allow Resident Doctors to obtain permanent higher paid posts in the NHS at the completion if training. If there is no route to progress it becomes difficult to tolerate low paid temporary contracts with little security.

The Government’s Bargaining Chip

In withdrawing these training posts the Government is unilaterally punishing Resident Doctors for the failure of negotiations by both sides.

It is a bargaining chip with significant consequences; it negatively affects current Resident Doctors, who want to see the path to senior positions in the NHS. It damages the NHS by depriving the service of the skills of additional senior trained Doctors. It will negatively affect Patient Care.

Better training opportunities for Resident Doctors should be a given, not a negotiating tool. NHS leaders have often demonstrated their ability to shoot themselves in the foot and this is no better demonstrated by withdrawing training posts to leverage reluctant compliance.

Creating 4000 new training posts over the next 3 years only begins to deal with the gap between applicants and jobs, and its urgent implementation should surely be independent of any industrial action. 

Services most affected

The NHS’s own data shows that the shortage of training posts affects both competitive and critical specialities. Each training post receives mutiple applications, most of which are unsuccessful.

Competitive specialities include:

• Community sexual and reproductive health – with 99 applicants per Training post

• Cardiothoracic surgery - with 73 applicants per Training post

• Public Health – with 29 applicants per Training post

• Neurosurgery - with 27 applicants per Training post

• Psychiatry - with 22 applicants per Training post

• Ophthalmology - with 22 applicants per Training post

Clearly competiton is good, but these odds will discourage even the brightest and best Resident Doctors. Ironically, all these specialities have seen significant reductions in service quality over the last 15 years.

Critical specialities

Those specialities where the lack of training post directly threaten service delivery include:

• Anaesthetics, which has become a critical bottleneck. Despite high demand for surgery, hundreds of doctors who complete core training are unable to secure higher specialty (ST4) posts each year.

• Emergency Medicine where competition has surged from roughly 2 applicants per post in 2019 to 14 per post in 2025. A&E Departments are subject to increasing pressures and long waits, and yet we provide insufficient training posts to deal with the demands on the service.

• Even General Practice where competiton was previusly regarded as relatively low, now has a ratio of 5 applicants per post.

With entry to Higher Specialist training, which leads directly to Consultant positions, the situation is just as critical.

• General Medicine has 11 applicants per Higher specialist training post

• Occupational Medicine has 17 applicants per Higher specialist training post

• Paediatrics has 10 applicants per per Higher specialist training post

This is a recruitment and training gap that requires urgent attention by the Department of Health, outside any dispute with Resident Doctors.

The Impact of the 1000 Withdrawn posts

Based on current vacancy rates and service pressures the loss of 1000 training posts will inevitably have a significant impact. This is not a short term issue but will require investment in training over many years, beyond the initial 3 year plan.

In General Practice there has been a decline in fully qualified GPs, with 469 fewer full-time GPs in February 2026 than in 2015, despite a 13.8% rise in patient numbers. Shortages are particularly acute in rural and deprived areas.

In Secondary Care although the medical workforce has grown in hospitals, vacancies remain high. The withdrawal of these additional posts prevents the conversion of existing short-term "locally employed" roles into permanent training positions, which were intended in part to stabilise hospital rotas. 

Long Term

The Governments strategy to convert training posts into a bargaining chip in an industrial dispute is ultimately good for nobody. It does not deal with the Resident Doctors dispute - if anything, it entrenches the dispute further by withdrawing a welcomed compromise. It is bad for the NHS and bad for Patient Care.

In Scotland the Resident Doctors pay dispute was ended with a 2 year settlement for 2025-27 with an average end-of-year pay uplift of 9.9% for 2025/26 and 9.4% for 2026/27. The deal included a new Resident Doctors Contract and a Pay Review Body to prevent future pay erosoion. Compromise was required - on both sides - to bring the dispute to a conclusion.

Surely it is not beyond the Department of Health to devise a similar deal? The abolition of training posts is not the answer.

So what is the future?

I have always argued for proper funding of healthcare and I am convinced that staff who work hard in the NHS should be able to follow their dreams and aspirations.

If you are a Resident Doctor, whether on strike or not, I would love to talk to you.

The first step could be to book a free no obligation 30 minute on-line conversation with me here. If I am not the right Coach for you, I will recommend somebody else who will be.

Please check my website and sign up to my mailing list if you want to receive more posts like this directly to your inbox.

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