Health secretary Wes Streeting has doubled the number of new specialist training posts on offer to resident doctors in England, in an attempt to head off a five‑day strike in the week before Christmas that NHS leaders warn could hit services during a sharp winter flu surge.

The revised package, unveiled on Tuesday, increases promised extra specialty training places from 2,000 to 4,000 over three years and introduces emergency legislation to prioritise UK‑trained doctors for those posts. But it contains no additional pay rise, falling short of doctors’ demands for a 26% real‑terms restoration in salary, and will only be implemented if strike action is called off and the dispute is brought to an end.

The British Medical Association’s Resident Doctors Committee (RDC), which represents doctors formerly known as junior doctors, has agreed to put the offer to members in an online survey closing on 15 December. If a majority back calling off the 17–22 December walkout, the union says it will proceed to a formal referendum on the deal. If they reject it, the five‑day all‑out strike – the fourteenth round of action since 2023 – is expected to go ahead.

At the heart of the offer is an attempt to tackle what both ministers and the BMA call a “career bottleneck”. Around 30,000 doctors applied for roughly 10,000 specialty training places this year, leaving about 20,000 without a route into formal specialist training and stuck in short‑term “locally employed” contracts. The Department of Health and Social Care (DHSC) says the extra 4,000 posts will largely be created by converting those local jobs into recognised training roles, with 1,000 posts brought forward to start in 2026 if the package is accepted.

Streeting has also promised emergency primary legislation early in the new year to reshape who can access those posts. The law would require NHS employers to prioritise graduates from UK and Republic of Ireland medical schools, along with doctors with significant existing NHS service, for foundation and specialty training places. Streeting told MPs he expected the changes to cut competition for some specialties from around three‑and‑a‑half to one, to under two applicants per place.

The shift marks a clear turn away from the previous open‑competition model that treated international medical graduates on the same footing as UK‑trained doctors. Streeting’s wider 10‑year workforce plan already instructs English trusts to sharply reduce reliance on overseas‑trained medics and “put home‑grown talent first”. The BMA itself passed policy earlier this year calling for UK‑trained doctors to be given priority in specialty recruitment, arguing that surging applications from abroad without a matching increase in posts risked creating a “lost generation” of domestically trained doctors.

Alongside the new posts and legislative changes, the package includes a set of cost‑of‑working measures. The NHS would meet the cost of Royal College exams, professional portfolios and membership fees for resident doctors, with exam fees backdated to April. The allowance paid to less‑than‑full‑time trainees would rise by 50% to £1,500. However, Streeting has ruled out reopening the 2025–26 pay round, insisting that resident doctors have already received cumulative salary increases of 28.9% since 2023 and that government efforts must now focus on training and progression.

For the BMA, which has built its campaign around a claimed 26–29% real‑terms pay cut since 2008 and the slogan of “full pay restoration”, that is a significant omission. The RDC has described the new offer as a “jobs” deal rather than a pay settlement. Its chair, Dr Jack Fletcher, told members the concessions on training and fees were only forthcoming because “thousands of resident doctors [were] prepared to stand up for their profession and their future”, but the committee has stopped short of recommending acceptance.

Streeting, for his part, is trying to drive a wedge between BMA leaders and rank‑and‑file doctors. Framing the offer as a moment of choice, he told the Commons that resident doctors could either continue with “damaging industrial action in which everyone loses” or back “more jobs, better career progression, more money in their pockets, and an end to strikes”. He has accused the BMA leadership of “wilful casualness” in pressing ahead with a Christmas‑week stoppage, calling it “one of the most shameful episodes in the long history of the BMA”.

The stakes are heightened by mounting winter pressures. NHS England figures show around 1,650–1,700 hospital beds currently occupied by flu patients, a rise of more than 50% on the same point last year. Several hospital trusts have already declared critical incidents. Sir Jim Mackey, NHS England’s chief executive, has branded the planned December walkout “cruel and calculated to cause mayhem”. Each round of resident‑doctor strikes is estimated by the government to cost the service about £250m in cover and lost activity.

Streeting has further linked the reforms to the end of the dispute by making their delivery explicitly conditional. DHSC officials say the 4,000 training posts and emergency legislation will not proceed if industrial action continues. Ministers also offered to back an extension of the BMA’s legal strike mandate into early 2026, to give time for a full ballot on the package, in return for cancelling the December strike dates; that proposal was rejected by the union.

The confrontation has become an early test of Labour’s claim to combine fiscal restraint with a reset of relations with NHS staff. Public support for the doctors’ strikes, which was above 50% when action began in 2023, had fallen to around 26% by mid‑2025, according to polling. If resident doctors now reject a package that many NHS leaders describe as “constructive” and “decisive”, they risk further eroding that backing. If they accept, they will have won major structural concessions on training – but not the pay restoration that sparked the dispute.