Alex Adamo, chief executive of The Commercialiser, a global negotiation firm, explains how the NHS resident doctor dispute could be resolved.
Another strike. Another press conference. Another failed round of talks. The NHS resident doctor dispute has entered a cycle of noise without movement; public patience is wearing thin and political capital is evaporating. But this is not just about pay, that is just the surface narrative. We are witnessing a negotiation breakdown at its core, with both sides in a behavioural deadlock. This failure of behavioural design and commercial architecture has locked both parties into patterns that guarantee escalation, not resolution. But what are the root causes of the impasse?
No BATNA, no exit. No exit, no deal
While there are many issues on the negotiation table that the resident doctor’s union and government need to come to an agreement on, the crux of the main issue at play in these talks is that neither side has a viable best alternative to a negotiated agreement (BATNA). For example, whilst doctors cannot mass resign and walk into equivalent jobs, the government cannot replace them at a fast enough pace without risking the collapse of the NHS.
Therefore, with no walkaway power, both parties are trapped in ritualistic bargaining and what follows is an echo chamber of threats and posturing instead of progress. This is not brinkmanship, but more a stalemate as a negotiation without alternatives is a negotiation without movement. Until one side builds credible leverage or both realign on outcomes, this will keep circling with no exit ramp.
Public posturing vs. private progress
The public nature of this dispute is part of its poison. Every press release risks reinforcing entrenched positions, and every headline can make compromise look like capitulation. Effective negotiation relies on fluidity, yet the current atmosphere often prioritises optics over outcomes. These conversations are often too nuanced to unfold productively under constant public scrutiny. A shift toward more private, constructive engagement could allow both sides the space to explore solutions so that when agreements are reached, they can be shared with confidence and clarity.
Identity-based negotiations: Why this is deeper than pay
Crucially, this dispute is not just about pay bands. For many resident doctors, it is also about professional identity. There is a strong sent that their contribution to the healthcare system is essential yet not always acknowledged in ways that feel meaningful. While fair compensation is a core issue, it may not, on its own, address the deeper concerns around morale and respect.
Similar dynamics can be seen in other public service professions, such as teachers, military personnel, and frontline emergency workers. If progress is to be made, it will likely require more than financial offers. It would involve creating avenues for genuine recognition, a clear voice in shaping the future of the NHS, and a shared vision in which their role is both supported and celebrated.
Timeframe mismatch: Long-term careers vs. short-term governance
Another challenge in this dispute is a mismatch in timeframes. Doctors often plan around decade-long careers, valuing stability and long-term development, while political decision-making tends to operate in much shorter cycles. This gap can often make it difficult to foster trust; long-term professional commitments can be hard to reconcile with short-term policy horizons.
Unlike governments, which change over electoral cycles, doctors remain embedded in the system and feel the lasting impact of each policy decision. Similar misalignments in time perspective often derail investment negotiations, where differing priorities limit room for agreement. Bridging this gap may require structural solutions such as multi-year pay frameworks, inflation-linked contracts, and transparent, metric-based career pathways. Addressing these issues with a long-term view could help ensure the NHS remains a sustainable and attractive place to build a career.
Building the game board before playing
Right now, this process lacks a clear structure, and for meaningful progress there may need to be a shift from reactive negotiation to a mor deliberate, long-term design. This could involve mechanisms such as binding arbitration when discussions reach an impasse, multi-year compensation frameworks inspired by other structured professions, and aligning pay more closely with agreed service metrics to ensure a transparent link between performance and reward. Most of all, trust needs to be intentionally built into the system, rather than assumed. Agreements are more likely when there is a foundation of trust to begin with. By focusing on building the right framework, more constructive and lasting outcomes should naturally follow.
