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Junior Doctors ballot in England:   Key information

This year, junior doctors in England were given a pay uplift of only 2 percent.

Meanwhile, inflation is sky-high, and costs of living have risen dramatically.

This situation is not new. Junior doctors have experienced real terms wage decline since 2008. And since the start of the current four-year fixed pay deal – opposed by HCSA – junior doctors have been locked out of higher pay awards every single year.

We recognise that the DDRB pay review system is broken. HCSA is campaigning for reform. But the situation is urgent, and so HCSA is calling for junior doctors in England to participate in a full industrial ballot and show the government we will not put up with pay cuts.

The NHS cannot afford to continue losing us to careers abroad or outside of medicine. That’s why HCSA Junior Doctors are campaigning for pay restoration.

Who is the ballot for?

The ballot is for all HCSA junior doctor members employed by the NHS in England. This includes locally employed junior doctors.

If you are a junior doctor in England but not yet an HCSA member, join today to take part in the ballot.

You will not be able to participate if you fall into any of these membership categories: Consultant, Specialist, medical student, junior doctor working solely in the private sector, or a doctor in Scotland, Wales or Northern Ireland.

It is important that all of the medical profession show support for junior doctors as a united front. You can download HCSA’s talking points on pay to equip you to have conversations in the workplace. As the campaign progresses, there will be further opportunities to get involved.

When will the ballot open?

Ballot papers will be sent out by post on 14th December 2022. You must keep an eye out for the letter arriving in the post in the days immediately following this date, so you can return it as quickly as possible.

Between now and then, it’s vital you get involved in the campaign. Make sure you have updated your contact details and remind your colleagues to do so too. You can download HCSA’s talking points on pay here.

What does my vote mean?

The ballot paper will ask whether you are willing to take part in strike action. By voting Yes to strike action, you are indicating that you are prepared to withdraw your labour. This means not attending work and not receiving pay on strike days. We firmly believe this action is the most effective way to make our voices heard.

Any member can choose not to participate in strike action – but imagine the power if all doctors stand together on pay. The more powerful our actions, the quicker the situation will be resolved.

Read our FAQs below if you have concerns about how strike action affects patient safety, your training or your visa.

How do I participate in the ballot?

If you are a junior doctor or locally employed junior doctor and based in England, ballot papers will arrive to your home address by post. You must complete the paper and return immediately by post using the envelope provided.

We are conducting the ballot by post because it is a legal requirement to do so, and if we chose to conduct the ballot electronically it would be considered unlawful.

What does a successful ballot result look like?

We can only move to strike action if at least half of those who receive ballot papers send them back, and the vast majority of votes are in favour of strike. This is because trade union law requires that 50 percent of those eligible for the ballot take part, and that at least 40 percent of those eligible vote in favour for us to proceed.  

It is crucial that eligible members participate. Remind your colleagues to take part and encourage non-members to join HCSA so they can participate.

What will happen if the ballot result is a vote for strike action?

If members vote for strike, our Dispute Committee will move quickly to coordinate the action. By law, all instances of strike action would have to happen in the six months that immediately follow the ballot closing. We would be required to hold another ballot if we were to continue taking action beyond this date.  

Junior doctors will receive communication from our Dispute Committee, which will make clear when the strike action will take place. 

You must not take any action other than that which is recommended by our Dispute Committee, otherwise you will lose legal protection.  

The Dispute Committee may urge you to attend a picket line outside of your workplace to show support for the action. There are regulations governing picketing, including a limit of 6 people on picket lines. We will provide clear instructions in the event of a vote for strike.  

Will HCSA strike action be coordinated with other unions?

Yes. HCSA meets regularly with other health unions. If members vote for strike action, our Dispute Committee will consider which dates would be most impactful, taking into account the actions of other health unions.

What about patient safety?

In the case of a junior doctor strike, employers would identify emergency cover from within the ranks of senior doctors and other staff grades. Employers are ultimately responsible for maintaining the safe provision of their services during all times, including during strike action. 

For more information, read the GMC’s position on industrial action.

Patients are already suffering because of policy on pay. Vacancies are rising, as doctors leave the NHS because they don’t feel valued. That’s why this action is so crucial – a proper pay award will help retain junior doctors. Strike action is not a decision doctors take lightly, but we need to make the government understand that the current situation cannot go on.  

Am I protected if I choose to take strike action?

Doctors, like other UK employees, have the right to take part in lawful industrial action, including strike, under employment law. The GMC has confirmed thisThere are legal protections from unfair dismissal for the first 12 weeks of taking lawful industrial action, and there is limited protection after 12 weeks. 

It is possible that an employer could attempt to discipline you for striking, but it would be impractical and counter-productive where there are many employees taking action at once. HCSA will coordinate with other unions to make it impossible for employers to target individual members. If any employers decide to take action against HCSA members for participating in strike, HCSA will provide support to affected members.   

Striking does not break continuous employment if you return to work after the strike ends.

How would strike action affect my training?

Participating in strike action is considered time out of training (TOOT), since you will not be gaining competencies on these days. You must declare any time out of training on your Form R for the Annual Review of Competency Progression. If strike action results in a breach of your quota, it is possible that you will be required to extend training or undergo a review of competencies at your ARCP meeting. The final decision will be taken by the Deanery. 

If an exam coincided with strike action, you would be able to take the exam as usual.

How would strike action affect my current visa?

If you are absent from work to participate in legally organised strike action, then this will not affect your work visa and your sponsorship cannot be withdrawn on these grounds.  

Reduction in your pay as a result of strike action also will not affect your work visa. Your employer is legally required to report reductions in pay to the Home Office, but if it is as a result of legally organised action then this cannot be used to end your sponsorship. 

Please be aware that consecutive, unauthorised absences of 10 days or more are reportable to the Home Office, including those related to strike action. HCSA's Dispute Committee will confirm planned actions and their durations after the ballot has closed. In the event that actions will affect your unauthorised absence period, contact HCSA for advice on 

For more information on above, please see government 'Workers and Temporary Workers'  guidance.

How would strike action affect my application for Indefinite Leave to Remain (ILR)?

If you are applying for Indefinite Leave to Remain (ILR), absence related to strike action will not have a negative impact on your application. Your employer will have to provide a list of absences from work to support your application, but any related to strike action will not detriment the decision.  

Reductions in salary as a result of strike action will not have a negative impact on ILR applications. Your employer should confirm your gross annual salary to demonstrate you meet required thresholds in Immigration Rules.  

Please be aware that consecutive, unauthorised absences of 10 days or more are reportable to the Home Office, including those related to strike action. HCSA's Dispute Committee will confirm planned actions and their durations after the ballot has closed. In the event that actions will affect your unauthorised absence period, contact HCSA for advice on 

For more information, please see the Statement of Changes to Immigration Rules Sept 2019.