Consultants have rejected a pay deal that would give some doctors a £20,000 rise in a knife-edge vote.

The British Medical Association (BMA) has now asked ministers to increase the offer, after 51 per cent of its members voted against it.

The union said that because the vote was so narrow, it sought to reopen pay talks.

The Victoria Atkins. the Health Secretary, said the Government was now “carefully considering next steps”.

Consultants had been asked to vote on a pay deal which meant an overall 4.95 per cent increase in the pay pot, with a rise of almost 13 per cent for some.

The overhaul of senior doctors’ contracts and pay scales meant greater reward for progression with the ability to reach higher levels more quickly.

Some 23,544 consultants took part in the referendum between Dec 14 2023 and Jan 23 2024, a turnout of 64.8 per cent.

The margins could barely have been closer, with 48.9 per cent voting in favour of the offer and 51.1 per cent against.

BMA keen to enter talks

While consultants have a mandate to strike until June 2024, the union said it was keen to enter talks with the Government to agree a deal.

NHS managers urged both sides to enter negotiations, with 1.3million operations and appointments now cancelled because of health service strikes at a cost of £2 billion.

Dr Vishal Sharma, BMA consultants committee chairman, said: “The vote has shown that consultants do not feel the current offer goes far enough to end the dispute and offer a long-term solution to the recruitment and retention crisis for senior doctors.

“It backs up conversations we’ve had with colleagues, who felt the changes were insufficient and did not give them confidence that pay erosion would be addressed over the coming years.

“In addition, they were concerned about the fairness of the offer and how it impacted different groups of doctors. There were also clear concerns about changes to professional development and time dedicated to teaching and research.

“However, with the result so close, the consultants committee is giving the Government a chance to improve the offer.”

The terms would have increased the most junior consultants’ pay to £99,532 per year, up £11,000 on the start of 2024, including a six per cent pay rise already given.

The offer does not include any recommendations made for pay rises by the independent pay review body for 2024-25. The most experienced senior consultants would get a pay rise that took their salaries to nearly £132,000, up by between £12,800 and £19,400 on the start of 2024, bringing more of them in line with the top pay point.

Rishi Sunak, the Prime Minister, had called it “a fair deal for consultants who will benefit from major contractual reform”.

These included enhancements for parental leave. The BMA had also agreed to end its use of rate cards, which have been used to charge hospitals thousands of pounds to cover shifts, including during strike action.

Matthew Taylor, chief executive of the NHS Confederation which represents senior managers, said: “This is a very narrow outcome and health leaders will hope that it will be used as a basis for reopening negotiations with consultants rather than to call for more damaging industrial action.

“Strikes have already led to over 1.3 million cancelled procedures and appointments and cost the NHS in excess of £1 billion.”

Fair and reasonable offer

Ms Atkins said: “I hugely value the work of NHS consultants and I am disappointed that after weeks of constructive negotiations the BMA has, by the narrowest of margins, rejected this fair and reasonable offer.

 “I want to build on our progress on waiting lists and for us all to be able to focus our efforts on offering patients the highest quality care. The Government is therefore carefully considering next steps.

“We already know the kind of progress our NHS staff can make in the absence of strikes – waiting lists fell by more than 95,000 in November, the first month without industrial action for over a year and the biggest decrease since December 2010 outside of the pandemic,” she added.

Wes Streeting, the shadow health secretary, said: “Last week, Rishi Sunak was bragging that NHS doctors had accepted his pay offer. This vote shows he was trying to pull the wool over the public’s eyes.

“The NHS is in the second year of strikes. They have cost patients more than one million cancelled operations and appointments, and cost taxpayers £2 billion.

“It is long past time Rishi Sunak took personal responsibility and took charge of negotiations himself. The Prime Minister cannot continue to wash his hands of the crisis in the NHS.”

Meanwhile the BMA has announced a fresh ballot of junior doctors on another six months of strikes but for the first time they will be asked about working to rule.

The union said this would “preserve” its ability to take industrial action when the Minimum Service Level Act takes effect. Under the legislation, employers can insist on a safe level of cover.

It would also mean that doctors fed up with striking, or who are not prepared to lose more pay over it, would have another route of protest.