NHS junior doctors have voted to reject the government’s final offer on their new contract, despite weeks of talks to try to broker a settlement.

Almost six in 10 junior doctors and medical students (58%) working in England who belong to the British Medical Association refused to accept the deal, with only 42% endorsing it.

About 37,000 BMA members, or 68% of the 54,000 trainee doctors and final and penultimate-year medical students who were eligible to vote, took part in the ballot, which closed on Friday.



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Dr Johann Malawana, the chair of the BMA’s junior doctors committee (JDC), who had recommended the revised terms and conditions as the best settlement junior doctors could get, resigned from his position after the results were announced on Tuesday.

“The result of the vote is clear, and the government must respect the informed decision junior doctors have made,” Malawana said. “Any new contract will affect a generation of doctors working for the NHS in England, so it is vital that it has the confidence of the profession.

“Given the result, both sides must look again at the proposals and there should be no transition to a new contract until further talks take place.”

Jeremy Hunt, the health secretary, said the outcome was “extremely disappointing” given that the contract was agreed with and endorsed by Malawana.

Hunt sought to portray the result as undemocratic, saying: “The BMA’s figures show that only 40% of those eligible actually voted against this contract, and a third of BMA members didn’t vote at all.”



He gave no indication of what he would do next. “We will now consider the outcome.” However, Whitehall sources said that junior doctors would start being moved on to the new contract from this autumn as originally planned, despite their vote.

But medical organisations are worried that imposing the terms and conditions will exacerbate the NHS’s worsening medical staffing problems.



NHS Employers, which in May had taken part in eleventh-hour negotiations brokered by arbitrator Acas, urged junior doctors not to stage any further walkouts as part of the dispute.

“I am profoundly disappointed the BMA has rejected the proposed new contract for junior doctors,” the chief executive, Danny Mortimer, said. “It is imperative that patients will not be made to suffer any further impact as a result of the rejection of the contract.”



The prime minister’s spokeswoman said that David Cameron was “disappointed” and added “we are considering the options at the moment”.

She argued that the contract had been good for doctors in that it delivered a substantial pay rise and was good for the NHS because it supported patients and moved towards a seven-day service. The contract had been due to be implemented in a rolling manner as trainee doctors moved into new jobs, she added.

“We have sought to work with junior doctors,” she added. “The prime minister firstly recognises there are different views across the junior doctor community with lots wanting to work and put patient care first. But it is also important that they recognise the offers of the new contract.”

Norman Lamb, the Liberal Democrats’ health spokesman, blamed the government for pushing a “fundamentally flawed” contract in pursuit of its seven-day NHS, even though the service was too understaffed to deliver it.

“Junior doctors have voted decisively to reject this new contract because it is fundamentally flawed. It was another dangerous attempt by the Conservative government to stretch NHS resources too far,” he said. “The plan to increase the number of hours worked at the weekend, without ensuring that sufficient junior doctors are recruited and trained in the short term, would inevitably have meant that cover was reduced during the week. This would have a disastrous impact on patient safety at a time when many weekday rotas around the country are already left unfilled.”

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It is unclear what will happen next, including whether there will be any more strikes. Hunt had warned that he would impose the contract from October if it was rejected.

Malawana said Hunt’s controversial handling of the nine-month dispute had contributed to the outcome of the vote.

“Having spoken to many junior doctors across the country in recent weeks it was clear that, while some felt the new contract represented an improved offer, others had reservations about what it would mean for their working lives, their patients and the future delivery of care in the NHS,” he said. “There was also considerable anger and mistrust towards the government’s handling of this dispute.”

Dr Mark Holland, president of the Society for Acute Medicine, urged Hunt not to impose the contract this year. “The rejection of the new contract by junior doctors is no surprise. Most people I spoke to were unhappy with the most recent proposal.

“[Hunt] should acknowledge the frustration of junior doctors and, in the context of a workforce crisis, halt the new contract for this year. He should then invite senior leaders within the medical profession, such as the president of the Royal College of Physicians, to work on a whole package of measures which make training in medicine enjoyable again.”



Malawana added: “These concerns need to be fully addressed before any new contract can come into effect and, in light of the result, I believe a new [JDC] chair will be better placed to lead on this work.

“There is much to do in order to rebuild the trust that has been eroded over the last year. The government must now do the right thing, accept the outcome of this vote and work constructively with the BMA to address junior doctors’ concerns with the new contract.”