On Wednesday, the British Medical Association (BMA) announced that a “referendum” of junior doctors and medical students in England had rejected by a clear majority the contract it had agreed with the Conservative government last month.

The deal seeks to impose a radical reduction in payments for working out of hours and Saturdays and undermines safeguards against working excessive hours. Some 58 percent opposed the agreement, in a 68 percent turnout of the union’s 55,000 members.

For over four years, the Conservatives have sought a new contract, seeing it as key to imposing seven-day working as standard practice on all National Health Service (NHS) workers, without increasing funding or staffing and rapidly increasing the privatisation of health care.

The junior doctors have remained steadfast, holding six strikes including the latest in April during which emergency cover was withdrawn—the first ever in the history of the NHS. Many recognise that what is at stake is something far greater than their own immediate interest and that the imposition of the contract will dramatically affect the livelihood of all workers in the NHS and its future as a public service.

Following the announcement of the ballot result, Health Secretary Jeremy Hunt declared, “It is extremely disappointing that junior doctors have voted against this contract, which was agreed with and endorsed by the leader of the BMA Junior Doctors’ Committee [Dr Johann Malawana] and supported by senior NHS leaders.” He declared that “the only realistic way to end this impasse” was to impose the new contract.

Malawana, who had attempted to sell the deal in scores of “roadshows” across the country, has been forced to resign, saying, “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. There was also considerable anger and mistrust towards the government’s handling of this dispute.”

Some indication of the opposition to the BMA’s capitulation appeared in the comments pages of the health professional website, Pulse. One medical student declared, “The BMA obviously gave in. There should be no compromise…!!”

Another wrote, “The new deal is quite frankly s**t! In no other industry is weekend working 9am to 9pm regarded as standard working hours. The juniors should reject the new deal without thinking twice.”

A general practitioner (GP) remarked, “The BMA has given in too easily—as usual. Still a pay cut. Vote against it and resign from BMA.”

Another health worker added, “In what profession would anyone be happy taking an averaged 30% pay cut? Especially as the price of registration, indemnity and exams are increasing along with the cost of living. Doctors have been down trodden and reduced in respect and trust by this government and others to enable better political control. …”

Despite these sentiments, which were expressed in yet another resounding vote against the government’s plans, it is clear the BMA is intent on sabotaging any further action. According to BBC Health correspondent Nick Triggle, “The Brexit [referendum vote to withdraw from the European Union] fall-out means that behind the scenes the BMA has now accepted its fight has to end.

“Several influential voices in the organisation have told me there is nowhere to go regardless of the result—with one saying any more industrial action at the current time would be ‘just ridiculous’ given what is happening in the country.”

Triggle reveals that during the ballot, the NHS “has been quietly continuing the process of implementing the new contract. ... Some 6,000 medics fresh out of medical school are due to start on the new deal from August” and “Much of the rest of the workforce will follow over the coming year.”

It cannot be clearer that the dispute has to be taken out of the hands of the BMA and the other health unions. They have done everything to isolate strikes, refusing to unite junior doctors with other health service workers in struggle, most recently those fighting the government’s scrapping of NHS bursaries. GPs are to be balloted for action over the government’s reactionary General Practice Forward View proposals, but only in three month’s time!

Junior doctors should form independent action committees to take their fight forward, in a unified struggle with other workers. This fight is a political struggle that cannot be carried out through the Labour Party. It has refused to officially support the strike, and fewer than 50 MPs turned up to debate the NHS Reinstatement Bill, which was presented as restoring the NHS to public ownership, ensuring it fell.

Independent action committees are also essential for developing the struggle of teachers, who took strike action on Tuesday after a 92 percent vote in favour. Officials from the National Union of Teachers (NUT) claimed that teachers “solidly” supported the strike, with hundreds of schools affected, either closing completely, or teaching “reduced subjects.”

Like health workers, teachers are faced with the privatisation of an essential public service, this time through the “academisation” process. Statutory education is being removed from local authority control and handed over to independent academies, many of which are being privately funded. Multi-academy trusts are also being encouraged to make them more attractive to global education corporations.

There has been widespread opposition to this development from across the teaching profession and from parents. But the unions have been complicit from the early days of the introduction of academies under the 1997-2010 Blair Labour government. Their only concern has been that the break-up of national pay structures could impact their negotiating rights with the government and, through this, their privileged positions.

Teachers must organise meetings in every school, independently of the unions, to discuss how to combat the government’s privatisation agenda, and organise committees in defence of public education and link up with workers under attack in the NHS and elsewhere. Above all it requires the building of a genuinely socialist and internationalist party—the Socialist Equality Party—that fights for the reorganisation of economic life on the basis of social need, not private profit.