This is going to hurt

Then, bearded young men in starched white coats took action against new contracts requiring junior doctors to work punishing hours for poor pay. Barbara Castle, Labour’s health minister, was forced back to the negotiating table. Now, junior doctors are just as likely to be female and wearing scrubs. Many, like Grote, are convinced the action is right.

“Just four years ago we reached a new pension deal with the government that everyone agreed was fair and affordable, and now this government wants to renege on it,” she said. “That’s what’s angered everyone in medicine. It’s making a deal and sticking to it.”

However, many of her colleagues were deeply uncomfortable last week as they prepared for a protest that carries high stakes. Thousands of operations will be cancelled and patients will go back on the waiting list for treatment.

The BMA says patient safety comes first and that urgent and emergency care will be given as normal. At the same time, the union wants to make an impact and a series of similar strikes could follow. In hospitals, BMA representatives will meet employers to decide who gets treatment and who does not. Cancer patients, yes. Mothers in labour, yes. Hip replacement? Not likely.

When David Cameron said in 2008 that a Conservative government would start to dismantle the generous pension schemes enjoyed by 4.5m public-sector workers, doctors imagined they were exempt. After all, earlier that year they had done a deal with Labour that they thought would last for a generation.

The changes leave medics still in a relatively enviable position in retirement They were in for a shock. With a financial meltdown and a new era of austerity there was little sympathy for the generous, salary-linked retirement payouts that the deal allowed them.

According to the Department of Health, a typical doctor earning £106,000 who retires at 60 will receive £48,000 a year for life, with a tax-free lump sum of £143,000. This equates to a pension pot of nearly £2m.

By comparison, a typical nurse earning £34,000, would retire at 60 on £9,000 a year with a lump sum of £27,000.

Most private-sector workers, if they have a pension at all, have ones linked to investments that have done badly since the 2008 crash. To them, as well as to most NHS workers, for whom the average pension is £7,300 a year — the doctors’ deal seemed the stuff of dreams.

So few, except perhaps the doctors themselves, were surprised when further reforms were announced.

For those on a salary of £45,000, contributions would rise to 9.3%. Doctors earning more than £120,000 would pay 14.4% of that into their pension fund, compared with 8.4% now.

The changes, to be phased in by 2015, leave medics still in a relatively enviable position in retirement. After all, professional workers, including doctors, live at least three years longer after retirement compared with 20 years ago so why should they not contribute more?

“They [the doctors] talk as if they were being singled out,” said a health department spokesman. “But why do they believe they should be exempt from financial constraint that is affecting the rest of the public sector, the private sector, the UK, and the global economy?”

The answer is clear, at least to many — mainly younger — more militant-minded doctors. The proposals will reduce take-home pay while at the same time raising their retirement age from 65 to 68. It is a slap in the face, they say, after years of hard training that have left many of them with tens of thousands of pounds of debt.

Ollie Mizzi, 28, is an emergency doctor at London’s Guy’s and St Thomas’ hospital who qualified in 2007. He voted for industrial action.

“In emergency medicine we often work a seven-day week: that’s 70 hours. It’s high stress and aggressive — I’ve seen staff getting punched. And I earn under £50,000 a year. Yet we’re now going to have to work longer to get a return. To do more for less.”

For him, and for other hospital doctors who spoke to The Sunday Times, anxiety over the NHS reforms hardened his stance. “This protest does feel very much like a last resort. There’s been no open discussion about our concerns. We don’t want to leave patients in the lurch but we have to make a stand.”

Andy Bowey, a 31-year-old trainee spinal surgeon at the Countess of Chester hospital in Cheshire, earns £30,000 a year but has a negative equity £150,000 mortgage on a two-bed flat in Liverpool. He says under the reforms he will have to operate well into his sixties to ensure a decent pension. “In the old days you would wind down towards 60. I’m not sure it’s good having a surgeon working hard at such a late stage in their life.”

There are other reasons why the doctors’ day of action is unlikely to attract much support. That is because many in the medical profession do very well indeed.

In the past 14 years, the average doctor’s salary has more than doubled from £36,722 to £74,721, according to the Office for National Statistics. Doctors have enjoyed an average annual increase of 5.39% compared with an increase in the average UK salary of 3.67% a year over the same period.

But not all doctors have benefited equally. An analysis by The Sunday Times, based on statistics from a number of sources, suggests that the average income of a hospital consultant has increased by 90% to £116,900 since the beginning of 2000, while GP partners earn 89% more: an average of £105,700. The basic salary of the average junior doctor has increased at a slower rate. It was £23,395 in 2000, and has risen by 37% to £32,000 now.

The group that has arguably benefited most are GPs because of their scope to earn more through a complex mix of dividends, expenses and “business growth” — based on numbers of patients. Consultants, meanwhile, say their opportunities for private work have declined.

According to the King’s Fund, an independent health think tank, if an entrepreneurial GP were to set up a new type of business, called an integrated care organisation, to manage health services for a large population, they could, with the benefit of bonuses, earn as much as £1m a year.

Andrew Lansley, the health secretary, lost no time last week in playing on the popular perception of some doctors as fat cats. “If a doctor works though their working life and arrives at a pension worth £68,000 a year that’s a [major] pension pot,” he said. “If you’re in the private sector you would have to go out and buy that; it would cost you nearly £1.5m.”

Not surprising, then, that in the BMA ballot that led to the day of action on June 21, many GPs and consultants at the top end of the profession were uncomfortable at drawing attention to pay and pensions.

In the ballot of 104,544 members, 84% backed proposals for a work to rule. The junior doctors were by far the most exercised, with 92% supporting action.Other doctors were appalled at the idea and the damage it could do to the profession.

Angus Ross, 42, who runs a GP practice in Kirkoswald, Cumbria, said: “I still can’t believe it. I think that it’s extraordinary it has come to this and a lot of other doctors are shocked as well.

“We all want good pensions and good pay, but it’s not an issue to strike over. We have been lucky enough to be in a position of privilege. We have had public and political support — I think that will be diminished for good.

“I don’t think that doctors care more about their pay than their patients but people will get that message. Doctors feel they have been badly treated because the existing pension arrangements were agreed in 2008 and they feel aggrieved that this has effectively been gone back on. You have to realise, though, that our terms and conditions, and pay, have all improved over the last 10 years. Doctors want to turn the clock back four years to a time that suits us but you can’t do that — why not turn it back 15 years, then we would all be paid less and work longer hours?

“It’s still a good pension and you can always pull out if you want to, but no one will because it’s still too good.”

This week, Lansley will write to the BMA, calling on doctors to be true to their word and protect patients — and in particular, not to compromise their “waiting time rights”, shorthand for the length of time patients wait for an operation.

The BMA says it is well aware of the delicacy of its position. It says it will do nothing to enforce the dispute, leaving clinical decisions to individual doctors. “We’ve told doctors if there’s any doubt over whether they should treat someone or not, they should treat them,” a spokesman said.

So the propaganda war has begun. Unhappily for the medical profession, it is already under siege. Even traditional sympathisers have distanced themselves. Labour has withdrawn its support for the BMA while the editor of the Lancet, Richard Horton, described the union’s decision as “a betrayal of its professional obligation to put patients first”.

A fortnight ago, Diane Abbott, the shadow health minister, said her party would support action that did not compromise patient safety. When the ballot results were announced, Andy Burnham, the shadow health secretary, urged doctors to “pull back from any form of action that damages patient care, including disruption to non-urgent care”.

Helen Grote is undaunted. “I am reasonably well paid; I don’t deny that. I am not moaning about my pay package as such. What I am disappointed about is the fact that the government has gone back on its word.”