Junior doctors in England have voted to keep on striking until the middle of September in their long-running pay dispute, bringing a new wave of disruption to the NHS. Those belonging to the British Medical Association voted overwhelmingly to stage further stoppages in addition to the 41 days of strikes held since last March. They backed a further six months of stoppages by 98% to 2% on a 62% turnout. There was nearly equal support – 97% in favour, 3% against – for taking action short of a strike, such as refusing to work overtime, in pursuit of a 35% pay rise. The renewed legal mandate means BMA junior doctors can take either form of action from 3 April until 19 September as long as they give the health trusts and GP surgeries they work for at least two weeks’ notice. Announcing the ballot result, junior doctors’ leaders repeated their plea to Victoria Atkins, the health and social care secretary, to make them a “credible” new offer. That looks unlikely, as Atkins has ruled out increasing the money on the table. NHS bosses said patients would have appointments and operations cancelled as a direct result of the next phase of the campaign. The medics are seeking a 35% pay rise as “full restoration” of the 26% drop in the real-terms value of their salaries since 2008. The vote is “another worrying escalation in this lengthy dispute between the government and junior doctors”, said Saffron Cordery, the deputy chief executive of the hospitals group NHS Providers. Several rounds of talks with ministers and civil servants at the Department of Health and Social Care have failed to bridge the gap between the BMA’s demands and the government’s readiness to offer junior doctors enough money to persuade them to call off their strikes. Dr Rob Laurenson and Dr Vivek Trivedi, the co-chairs of the BMA’s junior doctors committee, said it would be cheaper for ministers to settle the dispute than allow strikes to roll on. “The government believed it could ignore, delay and offer excuses long enough that we would simply give up. That attitude has now led to the NHS wasting £3bn covering the strikes. This is more than double the cost of settling our whole claim,” they said. This is the third time in a row that close to 100% of junior doctors have voted for strikes, despite the fact that most lose a day’s pay when they refuse to work. The prospect of renewed strikes came as new research showed all doctors in England had suffered a 25% fall in the real-terms value of their salaries since 2008. Their earnings fell even more sharply over those years than the average decline of 10% among workers as a whole, according to the analysis, which is published in the British Medical Journal. The findings, produced by the Office of Health Economics, an independent economics consultancy, supports claims by the BMA that the medical profession as a whole has experienced a significant fall in incomes over the past 16 years. That has hit doctors’ spending power because inflation has outstripped their pay. For example, newly qualified doctors, known as F1s, now spend 24% more of their salaries on essentials such as food, energy and housing than they did in 2008, the BMJ reports. Even consultants, who are much better paid, now have to spend 7% more of their disposable income on such goods and services than they did 16 years ago. One F1 told the BMJ that they could not afford to eat breakfast or join a gym. A former eye doctor, who quit medicine last year, said: “I loved medicine but I hated the pay and the way doctors are treated.” The health department said full-time junior doctors had had a pay rise of up to 10.3% for 2023-24, earned £47,600 on average and received a pension contribution of 20% of their salary. Separate research also published in the BMJ found that the NHS in England needed to receive £32bn more funding over the next four years than planned to help it end long waits for care. The finding, from the BMJ Commission on the Future of the NHS, comes amid rising concern in the health service that a projected £6bn shortfall in its budget in 2024-25 could lead to cuts. The health department said: “It is disappointing that BMA members have once again voted for industrial action, when we have already given junior doctors a pay rise of up to 10.3% this financial year and made clear in previous negotiations that further investment was available. “Overall NHS waiting lists have decreased for four months in a row, but further strikes will impede this progress, and more than 1.4m appointments and operations have now been rescheduled since industrial action began.”