Tens of thousands of junior doctors across England are striking from Tuesday for four days, the longest stoppage of any National Health Service (NHS) workers in a strike wave stretching back to last December.

The doctors, who comprise almost 50 percent of the NHS’s medical staff, will strike for almost 100 hours. This will have a massive impact, with their three-day strike in March resulting in more than 175,000 patient appointments and procedures being cancelled or postponed. An estimated 250,000 operations and appointments could be cancelled or delayed as a result of the four-day walkout.

Junior doctors are demanding an above inflation pay rise after 15 years of plummeting wages that have fallen by 26 percent since 2008. Newly qualified doctors are paid as little as £14.09 an hour. A January analysis by the British Medical Association (BMA) of junior doctors pay concluded that based on the Retail Prices Index (RPI) of inflation since 2008, “To achieve pay restoration by reversing this cut, would require a 35.3% pay uplift.” RPI stands at 13.8 percent.

Junior doctors voted in record numbers in a February BMA ballot to fight back, with 98 percent supporting industrial action on a turnout of almost 78 percent. Just 716 junior doctors (1.94 percent) opposed industrial action.

Ahead of the strike, Health Minister Steve Barclay penned an article in the pro-Conservative government Sunday Telegraph denouncing junior doctors for seeking a rise “widely out of step with pay settlements in other parts of the public sector”.

Government ministers held a COBRA meeting last week—called under conditions of national emergencies—with Barclay and Oliver Dowden, the Cabinet Office secretary. A government source told the Sunday Telegraph, “There was a lot of concern about the effects the strikes will have and that the BMA picked those dates to have maximum impact on all patients.”

The Telegraph editorialised, “Many will be astonished that those who claim allegiance to the health service are prepared to inflict such harm on it.”

The Tory government is entirely responsible for inflicting so much harm on the NHS that it is at the point of collapse, including a waiting list above 7 million.

The government and its media stooges are railing against the BMA for its “political militant stance”, claiming the union had made it a precondition of talks that the pay claim to be discussed is for 35 percent. The truth is that a major factor in the continuing collapse in pay is the below inflation pay deals accepted by the BMA for years, and the unions’ betrayal of a months’ long strike by junior doctors in 2016. The strike was ended by the BMA collaborating with then health secretary and current Chancellor Jeremy Hunt in the imposition of a vastly inferior contract.

The BMA is not demanding a 35 percent pay deal, or even a 26 percent pay deal, limiting its calls to vaguely seeking “pay restoration” with no time frame for this to be implemented.

In a March 23 statement, the BMA responded, “We have not made 35% a precondition to talks. In fact, we have set no preconditions—unlike the Health Secretary. The ask of 35% pay restoration is our starting position, and we are willing to meet with the Health Secretary anywhere, anytime, to negotiate what this might look like.”

Ahead of the strikes, the BMA bureaucracy stepped up its call for negotiations in two press releases published April 6 and 7. The first was headlined, “BMA tells Health Secretary he could stop next week’s junior doctors strike action with a credible offer to enable negotiations;” the second, “Is the Health Secretary really serious about ending the junior doctors' pay dispute and suspending next week's strikes?”

The BMA wrote, “Even at this late stage we stand ready to consider any offer the Minister tables—which, if credible, could mean the strike action being suspended—and we urge him to do so.”

Junior doctors beware! Precisely such an appeal to the government by Royal College of Nursing (RCN) leader Pat Cullen resulted in talks that led to a rotten deal that the RCN is trying to foist on its membership.

The RCN said even before the nurses strikes began that it would call them off if the government agreed to even sit down and talk about pay. The government rejected the RCN entreaties at that stage, and Cullen responded that the union would meet the government “halfway” on pay and settle for 10 percent. This was rejected and Cullen replied, as the BMA are now doing, that they would be prepared to consider “any offer”. On that basis the government agreed to talks, with a deal agreed that nurses are now in revolt over, with support growing for a no-confidence vote in Royal College of Nursing officials.

This record of treachery by the union bureaucracy has not only resulted in another year of below inflation pay deals being forced on thousands of NHS workers, but has prevented a joint offensive for better pay and working conditions and the defence of public health care. As a result, junior doctors are fighting alone this week and not in alliance with other health workers and others throughout the public sector, including education workers fighting a sellout of their dispute by the National Education Union bureaucracy and other unions.

Commenting ahead of the junior doctors’ strike, the Financial Times noted, “Last month the health unions Unison, the Royal College of Nursing and GMB urged their members to back the government’s pay offer of a one-off bonus and consolidated pay rise of 5 percent for the 2023-24 financial year.”

In his Telegraph piece, Barclay was able to cite the sellouts of the health unions to demand that the BMA get on with imposing a below inflation deal. All that would be negotiated is an “affordable offer… just as we have done with the trade unions representing other NHS staff including nurses and paramedics.” The BMA had to “work constructively with us so we can find a rapid resolution to this dispute.”

In every dispute the union bureaucracy has divided workers, whether on a job role basis—train drivers striking at different times to rail guards, or nurses and ambulance workers in stoppages on separate days—and on a local, regional and national basis.

The BMA in Scotland only began balloting its members on March 29, with the ballot not closing until May 5. They are voting in opposition to the Scottish National Party-Green government’s derisory pay offer for 2022/23 of 4.5 percent. Despite cynically noting the “courage of the English doctors”, BMA Scotland put forward no proposals for a joint struggle. It said instead that “exactly what form our first strike would take in the event of a successful ballot is being considered.”

Junior doctors must take the running of the dispute out of the hands of the BMA bureaucracy through the building of representative rank-and-file committees. Independent of the BMA leadership, these committees can reach out to nurses and other NHS workers to organise a counter-offensive against the governments in Westminster and Holyrood.

We urge junior doctors to contact the WSWS today to discuss forming a rank-and-file committee in your workplace.