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When do doctors’ strikes end? A perspective from 1975

by Jack Saunders

During the current junior contract dispute the events of 1975 have been a point of comparison for various commentators (including me in a Guardian piece), but there’s been little focus on the details of negotiations and what eventually settled it. In this blog I’ll be looking in detail at how the context around the last junior doctors’ strike, what happened and why eventually came to an end.

Although 1975 was the first time British doctors had officially gone on strike, it wasn’t the first conflict over pay in healthcare. The British Medical Association (BMA) had been active over doctors’ pay almost since its inception. From 1838 physicians fought over payments under the poor law, then from 1911 over money for free treatment administered by panel doctors. Even as the new national health service was being established in 1947, doctors debated the structure of their pay packets.

Although the 1950s and 1960s were largely conflict-free, dissatisfaction was building amongst many over the value of doctors’ pay. In 1962 the BMA’s complaints forced the government to establish the Review Body for Doctors’ and Dentists’ Remuneration (RBDD) and in 1966, 18,000 doctors threatened to resign en masse if their pay continued to decline. By 1975, both Labour and Conservative governments had spent thirty years barely avoiding direct conflict with doctors over pay, and with almost every other group of employees (including nurses) going on strike in the early 1970s the prospects for keeping industrial peace rapidly diminished.

The motivation for conflict when it finally came was a mixture of hours and pay. Prior to 1975, junior doctors had been paid extra whenever they worked above 80 hours a week, clocking 85.6 on average (43.2 on normal duty, 42.4 on call). Recognising this workload to be excessive, the RBDD proposed to reduce standard hours to 44, offering additional pay for any overtime.

Initially, some in the BMA were in favour of the new contract as it left doctors “better able to plan their lives”. However, with the Labour Government looking to restrain public sector pay, no new money was available and the scheme proposed reducing the bonus level for each additional hour by two thirds. Consequently, Junior doctors claimed the new contract would cut their pay and do little to curb excessive hours. Calling for no wage cuts and a 40-hour standard week, in October thousands of junior doctors organised bans on non-emergency work and various other kinds of collective action in different parts of the country.

Back then, junior doctors felt little need to brand their collective action as a defence of the service by proxy, instead arguing in terms of their living standards. One of their leaders, Dr Wasily Sakalo, an Australian doctor of Ukrainian descent earned particular notoriety as a militant in the 1975 strike, putting the doctors’ case in The Times:

“One of my sisters, Alla, who is 24, is a first-year house officer [in Australia] and she is earning £9,000 for 40 hours, with time and a quarter for overtime. She has been qualified for nine months. I have been qualified for seven years and I am on £4,500. It made me determined to try to obtain the same work conditions for British doctors.”

As historians David Wright, Sasha Mullally and Mary Colleen Cordukes note, by the mid-1970s NHS doctors formed part of an internationalising workforce, featuring migration in and out of Britain. Canada was a favoured destination, and during the 1960s approximately 8,000 British-trained physicians moved there, often being replaced by migrant doctors themselves. Consequently, many junior doctors were highly aware of their value on a global market-place. Then, as now, the prospects for “medical brain drain” were emphasised as the potentially disastrous consequence of their grievances being left unresolved.

However, unlike in the present dispute, the junior doctors’ actions were widely criticised by senior colleagues. One letter to The Times, by four London-based consultants read:

“The present dispute… is concerned with the relative affluence of doctors. It is not a fight to cure their poverty. Can it be right that a doctor be struck from the medical list for having sexual relations with a patient, while it appears to be legitimate to deliberately withhold treatment in the cause of doctors’ own financial gain?”

Despite their lack of external support and dependence largely on their own capacity for disruption, the junior doctors’ dispute dragged on for months of “go-slows”, partial strikes and walkouts, continuing the government found a further £2.3m to fund their overtime and concessions over hours. They finally resumed normal working in January 1976.

This partial victory for the doctors reflected in part the leverage that NHS staff wield when they stop work even in quite partial ways. The service often seems to teeter on the margins of functionality, and fairly small bouts of collective action can often send things rapidly out of kilter. In 1975, the NHS’ precariousness combined with the doctors’ own self-awareness of their value to the service to make it difficult for the government to force them back to work through moral pressure alone, even when that pressure was applied by their senior colleagues. Only when substantial extra money was found and a real improvement in working conditions offered did the BMA feel like it could finally persuade their members both to settle and, ultimately, to stay in Britain.

Securing a similar outcome with no new money and in the teeth of support from the public and other groups of NHS workers represents a huge problem for health minister Jeremy Hunt.

Do you remember the 1975 doctors’ strike? You can share your memories below.


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8 thoughts on “When do doctors’ strikes end? A perspective from 1975

  1. Prety selective interpretation – is it designed to mislead?
    ” Prior to 1975, junior doctors had been paid extra whenever they worked above 80 hours a week, clocking 85.6 on average (43.2 on normal duty, 42.4 on call). Recognising this workload to be excessive, the RBDD proposed to reduce standard hours to 44, offering additional pay for any overtime.”
    I qualified in 1966. At that time there was absolutely *no* limitation on the hours juniors worked – and no overtime: I went to USA a year later. When I returned in 1972, jumiors got overtime (at a third of normal working time)

    “in 1966, 18,000 doctors threatened to resign en masse if their pay continued to decline” weren’t these GPs?

    1. Hi,
      Happy to hear your memories of working in that period. The blogs on here aim to start up some discussion!

      The hours were reported in The Guardian on 19 September 1975 as the official rules at the time of the junior doctors’ strike, I’d be interested if they translated into reality. The 1966 resignations were indeed about GPs.

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  3. I was a pre-registration house officer at Leicester Royal Infirmary during the 1975/6 junior doctors’ strikes, and a member of the Medical Practitioners Union, affiliated to the TUC. The walk-outs and demonstrations spread thanks to the social media of the time, the TV news, and the BMA did not make the dispute official for 6 weeks, until it was clear how angry many junior doctors were. The industrial dispute petered out for a number of reasons: the BMA’s hospital junior staffs committee lost heart because they did not think the profession could break the Labour government’s pay policy (although it did, but few of us realised it at the time because the pay formula was so complex) ; public opinion began to turn after the death in December 1975 of an 11 month old girl in an ambulance seeking a functioning A&E department; and the BMA launched a campaign in defence of private practice that muddied the water. Overtime pay increased and hours of work declined somewhat, but it took until the 1990s for junior doctors’ hours of work to become a campaigning issue again.

    Together with Harvey Gordon I wrote a history of the 1975/6 industrial dispute,”Pickets in White”, published by the Medical Practitioners Union in 1977

    1. Thanks for such a knowledgeable reply. I found a copy of “Pickets in White” at the TUC library at London Metropolitan University. Did you remain an MPU activist after that? And what do you make of the present dispute?

      1. I stayed active in the MPU for some time, becoming a member of its national council and editor of its magazine ‘Medical World’; I stopped being actively involved in the 1990s because I thought it no longer had the ability to understand and adapt to change in the NHS. I am still a member, though.

        Current JDs work fewer hours but the in-hours workload intensity is much greater than it was in the 1970s – Lord Darzi estimated that in an average 8 hour shift a JD will get 100 tasks, one every 5 minutes, and will struggle to prioritise them and carry them out. That level of work stress is bound to have an effect individually and collectively – hence the massive vote for industrial action. I can see why they are angry at the possibility of having more overtime imposed on them, given that the NHS runs on unpaid overtime working and has a culture of bullying. Moving to Australia, where public hospitals are overstaffed by NHS standards and pay is higher, must be attractive – never mind that cost-containment is coming their way too, with some States spending 30% of their budget on hospitals. Having said that, the negotiations did seem to get close to an acceptable conclusion, and I suspect there is political belligerence on both sides; I think the BMA is using this junior doctor dispute as a “drawing out” battle to test its opponent’s nerve, flexibility and stamina before the big battles over consultant and GP contracts get underway. I am not sure that the JDs’ claim to be saving the NHS is justified.

  4. I was working in Yorkshire in 1975 and I remember when the doctors went on strike. I worked on a neurosurgical ward and our two junior doctors came onto the ward to attend to the patients , (some of the patients were on ventilators ,and we’re very poorly). The junior doctors from other wards who were on strike stood at the entrance to our ward and watched us all working. Some of them gave our doctors a hard time for strike-breaking.

  5. I was a clinical medical student at UCH London in 1975/76 and at that time senior clinical students were able to take on locum appointments for pre-registration House Officers. We were also able to take up night nurse positions on a regular basis which I did for several years. There was little medical disruption among junior staff in UCH as Consultants did not approve and they were your only referees for future jobs. Even holidays (2 wks) every 6mth appointment were very much for negotiation depending on Consultant attitude. During locum jobs in 76, 77 and pre-registration house jobs in 78 after 80 hours worked UMTS were paid at 1/3 rate until 120 hours. I cannot recall the rate after 120 hrs but my impression is it was less again. As a house officer and then a resident senior house officer I worked up to 123.5 hours on a 1/1.5 rota i.e. I had 1 night off in 3 and every 3rd weekend off. Most of us without family would do what needed to be done and plonk off to a bed on ward or residence without regard to hours. In all 3 of my jobs during that time it was common for nurses to provide me with breakfast.
    Things changed enormously for junior doctors in the early 90’s and pay and conditions are very much improved. Yes they have to jam in many tasks but their practical training shows huge gaps as there are many more seeing fewer patients and frankly much more supervision. By the time many junior doctors become consultant now they are already earning at consultant pay scale. The current dispute is about pay but fairness must now extend to many more women in medicine and that means part timers doing extended training and taking long breaks because of families. Hunt et al would like to hold back the seniority pay rewards for these and indeed penalise those taking education and research breaks. Hunt et al want to move many or most routine procedures and operations through 7 days but without the cost of more staff, medical, nursing, scientific that this entails. Their pledge is made without modelling, without costing and without the trained staff available to achieve it. Senior staff are strongly aware and supportive of a rational resistance to try to stretch their resource to an impossible political goal which of course Hunt et al would seize credit for with false statistics. All NHS staff groups are very aware of the true political purpose behind this junior doctors fight and nearly all except those who are taking the management handbag allowances are strongly behind the junior doctors purpose.
    In my view a failure to remove Hunt (urgent) and bring a new face in to reasonably negotiate terms and conditions for the junior doctors, the gps, the consultants and the nursing and scientific staff will destroy this gov. more certainly than their dithering approach to other issues, not least Brexit. Consultants are currently taking early retirement in droves broadly because of the gov. approach to conditions and training and contracts in the NHS. Many who would never have retired (also not good) are desperate to leave. If I was a junior now with all my same former passions and ambitions I would have resigned and flown to Australia last year. I would not be back. When I trained there were educational grants, service work opportunities, scholarships in reasonable plenty. Now these students have big loans to pay off.

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