What pay increases and pay review recommendations have been applied to junior doctors since 2023?
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Executive summary
Since 2023 there have been two main sets of applied pay decisions for junior doctors: the 2023 pay-review implementation accepted by government which delivered a consolidated 6% uplift plus a £1,250 payment (with some grades, notably first-year doctors, receiving larger percentage increases) and a later deal negotiated with the BMA in 2024 that the union recommended to members and which the parties described as delivering an average 22.3% increase across 2023/24 and 2024/25, including a backdated 4.05% element for 2023/24 on top of earlier awards (these figures and fiscal impacts are reported by Nuffield, Full Fact, BMJ, The Guardian and Sky) [1][2][3][4][5].
1. The 2023 pay‑review body decision implemented: 6% + £1,250 and who that helped
In mid‑2023 the government accepted the independent pay review body's recommendations for doctors and implemented a consolidated 6% uplift to basic pay for 2023/24 together with a £1,250 consolidated payment for junior doctors in England — a settlement the BMA described as inadequate and which did not stop subsequent strike action [6][1][2]. Full Fact and Nuffield Trust note that because pay scales vary by year of training the effective increase was larger for some cohorts: first‑year junior doctors saw basic pay rise by about 10.3% from April/September 2023 due to how scale points and backdating applied [2][1].
2. The 4.05% backdate and the two‑year “22.3% on average” package agreed with the BMA
Following prolonged industrial action, the Labour government and BMA leadership reached an agreement that the BMA committee recommended to members which the press summarised as an average 22.3% rise over two years (2023/24 and 2024/25); this package includes an extra 4.05% for the 2023/24 pay year backdated to April 2023 on top of the 8.8% awarded earlier in 2023, taking the 2023/24 uplift to an average 13.2% and forming part of the 22.3% two‑year headline figure [3][4][7]. Reporting varies in how it expresses the year‑on‑year uplifts by grade — press coverage gives ranges (for example Sky reported increases “between 8.1% and 10.3%” alongside the backdated 4.05% for 2023/24), reflecting differential scale impacts across training grades [5].
3. Fiscal and accounting caveats — who picks up the bill and when
Analysts flagged that the two‑year offer creates material additional costs for the NHS and for public finances, with Nuffield Trust estimating unfunded extra costs in the region of £530 million when excluding pension impacts and warning that the 2023/24 backdated element (now estimated at about £210m for that year) sits against an NHS England position that ended 2023/24 with only a small surplus — underlining budgetary strain and reporting uncertainty about how the backdated liabilities will be recorded [8].
4. What the pay review recommendations versus negotiated offers mean in practice
The DDRB recommendation accepted in 2023 set the baseline of 6% + £1,250; later political negotiation and union agreement produced additional, higher uplifts and backdating for 2023/24 plus further increases in 2024/25 that together are described as averaging 22.3% over two years — but that headline conceals complexity: some doctors already had the 8.8% uplift applied in July 2023, some grades benefited more from scale movements (hence the first‑year 10.3% example), and additional instalments (the 4.05% top‑up) were applied retrospectively [1][3][2][5].
5. Competing narratives and outstanding questions
Government and independent commentators emphasise DDRB conformity and affordability constraints, while the BMA frames the package as a hard‑won partial restoration of pay after years of real‑terms decline; fact‑checking outlets and academic analyses note that calculations of “how far pay has fallen” depend on inflation measure and time window, so the 35% restoration claim remains a political demand rather than an applied settlement [9][10][11]. Reporting also varies on exact percentages by grade and on the accounting treatment and funding source for backpay, so the public‑facing headline figures should be read alongside the detailed pay‑scale impacts and NHS financial statements [8][2].