Senior doctors have voted in overwhelming numbers to go on strike over pay for the first time in nearly 50 years, in an attempt to put pressure on ministers to reverse deep cuts to their salaries they have experienced since 2008. More than 24,000 consultants in England voted in the British Medical Association’s ballot (a turnout of 71%), with 20,741 (86%) voting to strike, securing a large mandate for stoppages far above the 50% legal requirement. Hospital consultants will strike for two days, from 7am on 20 July. That will bring major disruption to services that have already had to reschedule 651,000 appointments since a wave of NHS strikes began last December. The BMA consultants committee urged members to vote in favour of strike action after talks with ministers about restituting pay levels, which have declined in real terms by 35% since 2008-09, broke down. The vote will pile further pressure on the government in the week it plans to publish the long-awaited NHS workforce plan, which will set out how ministers intend to fix the UK’s crumbling healthcare system by plugging chronic staff shortages. News of the ballot result emerged hours after the prime minister, Rishi Sunak, hosted health leaders to discuss the plan. His spokesperson said it was a “positive meeting” but that pay was not covered. Nursing union leaders were also present. However, their members on Tuesday failed to vote in sufficient numbers for further strike action. The Royal College of Nursing general secretary, Pat Cullen, raised concerns that they had been deterred by mandatory postal voting. She said the RCN would continue to campaign for fair pay, including exploring options for action short of a strike, and would consider re-balloting members in future. The BMA announced late last week that thousands of junior doctors, who can have up to eight years of experience as a hospital doctor or three years in general practice, would go on strike across England for five days, in the longest such strike action in the history of the NHS, and their fourth in this pay dispute. More than 36,000 union members, out of about 75,000 junior doctors, will strike from 7am on 13 July until 7am on 18 July. They are joined by consultants for the first time since 2012. There are more than 58,000 consultants in the NHS, according to the latest figures, with 33,915 eligible to vote in the ballot. Dr Vishal Sharma, the BMA consultants committee chair, said: “We know consultants don’t take the decision around industrial action lightly, but this vote shows how furious they are at being repeatedly devalued by government.” Sharma said strikes could be averted if the government presented a “credible offer” for its members that would begin to reverse the real-terms pay decline and commit to changing the pay review process to better account for historical pay erosion. Without this, he said, more of the NHS’s “most experienced, highly skilled clinicians” would choose early retirement or leave the UK, which would be “devastating for services, patients and the future of the NHS”. He confirmed that while most routine and elective services would be cancelled, patient safety and emergency care would be prioritised, similar to the level of services typically available on Christmas Day. The BMA is not disclosing the government’s offer to consultants, but said it was a “real terms pay cut”. Junior doctors have been offered a 5% pay rise to end the dispute, which they have refused. The Department of Health and Social Care has since received a recommendation from the review body on doctors’ and dentists’ remuneration (DDRB) for 2023-24, which proposes a 6% pay rise backdated to April 2023, with an additional £1,000 for junior doctors. The DHSC said it was “considering carefully” the proposal and would publish its response shortly. The six-week lead time from the ballot’s launch will also enable consultants and their colleagues to put in place early plans to manage patient lists and prioritise urgent care. Consultants have been on strike twice before in NHS history. In 2012, consultants voted to refuse all non-urgent care for one day in June over pensions. In 1975 they suspended “goodwill activities” between January and April in protest against contracts they said would force them to abandon private practice. Sir Julian Hartley, the chief executive of NHS Providers, said trust leaders, staff and patients were “dreading industrial action by consultants next month, hard on the heels of a five-day strike by junior doctors”. He said this “double whammy” in effect amounted to “the longest single strike ever seen in the NHS”, and would result in disruption for thousands of patients, compounding the effects of eight consecutive months of strike action across the NHS. “This is a huge risk for the NHS to manage,” Hartley said, urging the government and doctors’ unions to “settle their differences”. He said: “We understand how strongly doctors feel – the high turnout in the consultants’ vote shows just how strongly – and why they are striking. Trust leaders will continue to do everything they can to limit disruption and keep patients safe but that’s getting harder and more expensive with every strike.” The Hospital Consultants and Specialists Association (HCSA) president, Dr Naru Narayanan, said strikes by senior doctors were unprecedented and used to be considered “unthinkable”. The Department of Health and Social Care said: “We hugely value the work of NHS consultants and it is disappointing the BMA consultants have voted to take strike action. Consultants received a 4.5% pay uplift last financial year, increasing average earnings to about £128,000, and they will benefit from generous changes to pension taxation announced at budget. “Strikes are hugely disruptive for patients and put pressure on other NHS staff. We’ve been engaging with the BMA consultants committee on their concerns already and stand ready to open talks again – we urge them to come to the negotiating table rather than proceeding with their proposed strike dates. “We urge the BMA to carefully consider the likely impact of any action on patients.”