Thousands of junior doctors in England are beginning another three days of industrial action Wednesday after talks between the British Medical Association (BMA) and the Conservative government collapsed five weeks into negotiations. A six-day strike will also take place January 3-8, making a total of 216 hours of industrial action—the longest strike in the history of the National Health Service (NHS).

The extended walkouts testify to the determination of the BMA’s junior members to win a 35 percent “pay restoration” increase. By the end of the January strike, assuming it goes ahead, the doctors will have taken 34 days of action over the last year.

But they confront their isolation and demobilisation at the hands of the health sector trade unions. Historic strikes by nurses and actions by ambulance and other hospital workers have been betrayed, leaving workers out of pocket and the junior doctors out on their own.

Now lumps are being taken out of the BMA dispute itself. A sell-out deal was put forward by the union leadership last month to end the fight of 59,000 senior doctors in England, threatening to divide them from their junior colleagues. Joint action between the two groups was held for the first time in NHS history over four days in September and October, having a powerful impact and receiving wide public support.

The offer amounted to an average 4.95 percent “investment in pay” for the 2023-24 financial year, adding to the miserly 6 percent already offered by the government.

Consultants have criticised the deal on social media, and their determination to win a pay rise addressing years of cuts was shown in their 90 percent vote (on a 60 percent turnout) to renew a six-month mandate for industrial action—announced Monday. But part of the deal struck by the BMA with the Tory government is that no further strikes of these doctors will be called until the result of the vote on the deal is announced weeks from now on January 24.

Further isolating the junior doctors, the BMA has also agreed a pay deal with the government for 12,000 specialty and specialist (SAS) doctors—staff who do not reach consultant grade but are no longer in training. Staff will receive between 6 and 9 percent in January, on top of increases of about 5 percent already agreed. The sell-out does not address the loss in real-terms pay inflicted by inflation over the last two years, let alone claw back the massive cuts in wages since 2010.

Something similar is being prepared for the junior doctors. Co-chairs of the Junior Doctor Committee, Robert Laurenson and Vivek Trivedi have said, “We will be ready and willing any time the government wants to talk. If a credible offer can be presented the day before, or even during any action, these strikes can be cancelled.”

Continuous references to a “credible offer” that will put doctors on the road to “pay restoration” make clear that the 35 percent demand is a dead letter.

The JDC said it walked out of negotiations with the government because it offered “an additional 3 per cent pay uplift… unevenly spread across doctors’ grades” and so “still amount[ing] to pay cuts for many doctors this year”. This would be on top of the 6 percent wage increase for 2023-24, plus a £1,250 consolidated payment, announced by the Sunak government in July.

This is the ballpark figure after five weeks of what the BMA claimed were “productive” talks with Tory Health Minister Victoria Atkins. Clearly the JDC felt this would never fly with members. But the senior and SAS doctors deals show there are at best 1 or 2 percentage points in it before the union moves to force acceptance.

Doctors, however, want to fight for more. More evidence was provided by the ballot result of 3,000 BMA members in Wales announced Monday—98 percent in favour of strike action on a 65 percent turnout. This follows their rejection of a 5 percent pay offer by the Labour-run devolved government.

Junior doctors’ pay in Wales has fallen by nearly a third (29.6 percent) in real terms since 2008/9. Pay is so low that Dr. Oba Babs-Osibodu and Dr. Peter Fahey, the co-chairs of BMA Cymru Wales’ junior doctors committee stated that “A doctor starting their career in Wales will earn as little as £13.65 an hour,” adding, “and for that they could be performing lifesaving procedures and taking on huge levels of responsibility.”

Following the overwhelming vote to strike, the BMA announced a 72-hour walkout, but set for January 15, separating workers in Wales from the action in England.

Doctors of all grades must recognise that their fight for fair pay is in danger if left in the hands of the BMA bureaucracy, whatever their occasional fighting rhetoric. Over the last 18 months, workers in their millions have been betrayed in every sector, their disputes sent down to below-inflation defeats, whether led by supposedly “militant” leaders like the Rail, Maritime and Transport union’s Mick Lynch, the Communication Workers Union’s Dave Ward and the University and College Union’s Jo Grady, or not.

Doctors must also have a strategy for taking on a government and opposition equally hostile to the NHS and to striking workers, armed with a raft of anti-democratic legislation.

Commenting on its refusal to award junior doctors a deal above the current RPI inflation rate of 6.1 percent, a Welsh Labour government spokesperson declared, “Our offer is at the limits of the finances available to us and reflects the position reached with the other health unions for this year. Without additional funding from the UK government, we are not in a position to currently offer any more.”

They added pathetically that the Welsh government would “continue to press” a Tory government enforcing ruthless pay suppression across the board “to pass on the funding necessary for full and fair pay rises for public sector workers.”

It would have as much trouble securing the money from a Labour government in Whitehall. Shadow Health Secretary Wes Streeting made Labour’s austerity agenda clear to everyone earlier this month by accusing the NHS of “using every winter crisis and challenge it faces as an excuse to ask for more money”.

He doubled down this week when asked Monday by BBC Breakfast whether his party in office would be “more willing to go closer” to meeting junior doctors’ 35 percent demand. Streeting responded, “I don’t want to set expectations in the wrong place, and 35 percent is a high number,” adding, “So we are going to have to make some hard choices.” NHS pay would be “a journey, not an event.”

NHS FightBack, initiated by the Socialist Equality Party, calls on doctors to form rank-and-file committees to campaign for a rejection of all below inflation deals. A call must go out for a renewed industrial offensive of all NHS workers sold out by the health sector unions to secure the wages and conditions needed by a modern 21st century health care service, paid for out of the fortunes of the super-rich. Contact NHS FightBack today to discuss the way forward.