Classification: Official

To:

• chief executives and medical directors
• communications directors

Dear colleague,

Update from Jim Mackey about industrial action in December 2025

I am sure you are aware that there has been a huge push over this last week or so to try and reach an agreement with the British Medical Association (BMA) that would allow the strike next week to be cancelled. Sadly, this wasn’t quite possible, but there remains a genuine possibility that the strike could be called off, subject to the BMA’s survey of members.

Key to this is resident doctor colleagues being able to see and understand the scale of the offer that has been made to the BMA, and how this would address many of the concerns they have expressed over recent months with regard to jobs, how they are valued and the training system.

So, I think we need to plan on the basis that the strike will happen and enact the plans that you have all developed and proven in the last 2 rounds can protect and provide care to patients who need us.

Alongside this, and this is really a very urgent effort for today and the next couple of days, we need to use every available avenue and mechanism to share the details of the offer, and its likely benefit to resident doctor colleagues, so they can make informed choices about whether to accept this or not.

What sits alongside this is a shared view between the BMA, resident doctors more broadly, education colleagues, royal colleges and our leadership community that the recruitment and training system needs a radical overhaul to make it more localised and personal, and a system that we all own and manage together. I am confident that, if we can get past this dispute, we can make this a reality and create a system that we are all proud of again, including resident doctors.

The BMA’s agreement to put the latest offer out to resident doctors in a survey provides a real route, if the response to that survey is positive, to them standing down the planned industrial action next week. Given the operational pressures we’re all facing, we really need to lean into this opportunity over the next 48 hours.

Central to the offer is:

• introducing emergency legislation in the new year to rapidly prioritise UK graduates and other doctors with significant experience working in the NHS for foundation and specialty training posts
• significantly increasing additional specialty training posts over the next 3 years from the 1,000 previously announced under the 10 Year Health Plan to 4,000
• delivering 1,000 of these training posts to start in 2026 via a new and improved application process
• introducing an alternative core training programme, with 650 roles also starting in 2026, which would enable current locally employed doctors to apply successfully for higher specialty training
• putting money back in resident doctors’ pockets, including through the funding of mandatory Royal College exam and membership fees
• starting a process of redesigning the recruitment and training system so that it is more personal, localised and sensitive to the needs of resident doctors and employers

This combination of prioritisation and expansion would make a quick and significant impact. It will transform the competition ratio for training places from nearly 4 applicants for every post as it currently stands, to less than 2 applicants per post in 2026. This should be a real boost for resident doctors going through the application process right now.

More broadly, if we can avert industrial action next week, it proves the potential to work with the BMA in a more constructive manner and provides the basis for optimism going into next year. The recovery you’ve been able to achieve over the last 9 months can only accelerate if we get to a place where we can end the cycle of strikes and focus our efforts on delivery.

The work you’ve all done, with your lead resident doctors, on the 10 Point Plan has played a really important role in getting us to this point – please keep going with all of that.

There is a stark reality in all of this though in that, if we have to continue with this dispute and more strikes, the money, good will and collaboration required to deliver the changes above will have been spent on covering the costs of this disruption, and the opportunity lost.

I know you and your teams are working round the clock at the moment, and the progress we have all made together this year is huge. You have my admiration and appreciation for all you have done, and continue to do, especially at this time of peak winter pressure. I know you will see that the leadership we show over this next couple of days in sharing this message, and demonstrating the value of this offer, can materially impact whether this strike is called off. We all understand how important this is to patients, other clinical and operational colleagues and our ability to keep patients safe.

Let’s all do all we can – prepare for the worst scenario but give the best a fighting chance.

Shout if you need anything and, keep going…

Kind regards, 

Sir James Mackey, Chief Executive, NHS England