The National Health Service (NHS) in England is bracing for another major disruption as thousands of resident doctors embark on a five-day strike starting Friday, November 14, 2025. This latest walkout, the thirteenth since March 2023, comes amid an intensifying dispute over pay between doctors and government officials. Health leaders are warning that, unless a resolution is found, the continued industrial action could force the NHS to cut frontline staff, reduce patient appointments and operations, and further lengthen waiting times for vital care.
According to both the NHS Confederation and NHS Providers, organizations representing health trusts across England, the ongoing strikes are putting immense pressure on already overstretched budgets and threatening the stability of the country’s healthcare system. The last strike, which took place in July 2025, was estimated to have cost the NHS a staggering £300 million. These costs, leaders say, are not accounted for in the health service’s tight budget, which is already under strain due to wider public sector financial challenges.
Matthew Taylor, chief executive of the NHS Confederation, did not mince words about the consequences for patients. “There is no doubt that patients will bear the brunt of this disruption, with tens of thousands of tests, appointments and operations likely to be delayed or cancelled,” Taylor said, as quoted by The Independent. He acknowledged the frustration patients feel, “being left waiting in pain or discomfort, not knowing when their treatment will be rescheduled.”
The impact of these strikes is already being felt. During the last resident doctors’ walkout, more than 54,000 procedures and appointments were cancelled or rescheduled, even as the NHS managed to maintain 93% of its planned activity. The knock-on effect has been particularly acute for those waiting for essential treatments, with some patients unable to work as a result of delays. NHS leaders caution that the strikes are undermining efforts to reduce the NHS waiting list, which, after three consecutive months of increases, only began to show a slight fall in September 2025.
Flu season is now beginning to bite, raising additional concerns about the NHS’s resilience heading into winter. Taylor warned, “With flu already beginning to bite there is a real risk that these strikes will leave the NHS limping into a very difficult winter at a time when it is trying to recover performance and implement vital long-term reforms.”
The financial toll of industrial action is a central concern. “Industrial action is also having a major financial impact on the NHS, with the last five-day walkout estimated to have cost a staggering £300 million. These costs are not included in the health service’s budget, which is already very tight given the strain on public sector finances,” Taylor explained. He added, “This means that more strikes will blow further holes in these constrained budgets and could result in leaders having to cut staff or reduce service levels in order to balance the books.”
Daniel Elkeles, chief executive of NHS Providers, echoed these worries, emphasizing that patient safety remains the top priority. “Trust leaders and their frontline teams are working flat out to manage the impact of industrial action, including asking other senior staff to step in and provide essential cover for their striking colleagues, while doing their own jobs,” Elkeles told the PA news agency. He stressed that derogation requests—emergency calls for striking doctors to return to work—are “initiated by trust-based medical directors, who are senior clinicians acting in good faith, to keep patients safe when unexpected and extreme circumstances arise during strikes.”
The British Medical Association (BMA), however, has made it clear that it will not agree to derogations unless certain conditions are met. In a letter to hospital leaders, Dr. Tom Dolphin, BMA council chair, and Dr. Emma Runswick, deputy chair, stated, “Derogations are not in place to avoid disruption caused by industrial action but to ensure that in unexpected and extreme circumstances patients will continue to receive safe care.” They added, “Derogations will not be granted if planning has not occurred to incentivise non-striking doctors to cover emergency work, or if non-emergency work is continuing.”
The pay dispute lies at the heart of the conflict. Health Secretary Wes Streeting has refused to move on the issue, pointing out that resident doctors have received a nearly 30% pay increase over the past three years. “We would urge them to call [the strikes] off, moderate their demands to something achievable and re-enter negotiations,” Taylor urged, calling the strikes “disproportionate, given the current financial environment and the fact resident doctors have already had one of the biggest pay rises in the public sector.”
The BMA, for its part, argues that doctors need a 26% pay uplift to restore their earnings to previous levels, once inflation is taken into account. The union has also criticized NHS managers for what they describe as “emotionally blackmailing frontline staff who are taking legitimate industrial action to defend their pay and conditions, and fight for employment.” Dr. Jack Fletcher, chair of the BMA’s resident doctors committee, said, “We cannot let the Government and managers gaslight the public into putting the blame for these system-wide failures at the doors of hardworking doctors who are standing up for their profession and the future of the health service.”
Adding to the complexity, NHS England chief executive Sir Jim Mackey has instructed hospital bosses to deliver at least 95% of planned activity during strike days and to avoid adopting the BMA’s rate card for paying medics covering for striking doctors. The BMA’s consultant rate card, which sets fees for work outside contracted hours, ranges from £188 per hour on weekdays (7am–7pm) to £313 per hour for overnight shifts (11pm–7am). Sir Jim’s letter also emphasized that rescheduling appointments and operations should “only happen in exceptional circumstances to safeguard patient safety.”
Meanwhile, the BMA’s current mandate for strike action runs out in January 2026, after which it would need to ballot members again to continue industrial action. Recent polling reported by The Times suggests a divided profession, with 48% of resident doctors wanting the action called off and only 33% supporting its continuation.
NHS England is urging patients to continue coming forward for care and to attend any planned appointments unless they are told otherwise. Emergency services, including 999 and A&E, remain available as usual, and NHS 111 is also operating alongside standard GP services.
As the standoff continues, both sides remain entrenched, with the government holding firm on its pay offer and the BMA insisting on a restoration of pay lost to inflation. The outcome of this dispute will have far-reaching implications not only for the NHS workforce but also for millions of patients relying on timely access to essential care. The coming weeks will test the resilience of the health service and the willingness of all parties to find a compromise that protects both staff and patients.
