Junior doctors in England have rejected the contract offer agreed between Jeremy Hunt and their union the British Medical Association, reopening the long-running dispute and risking a return to industrial action in the NHS.

About 37,000 junior doctors and final year medical students voted on the proposed contract in a ‘referendum’ called by the BMA after the contract terms were agreed following protracted negotiations and several waves of strike action earlier this year.

The new contract, which requires junior doctors to commit to more weekend working, was rejected with 58 per cent against and 42 per cent in favour, with a turnout of 68 per cent.

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Dr Johann Malawana, the chair of the BMA junior doctor committee, who led talks with the Government, said he would resign following the result.

Mr Hunt, the Health Secretary, said that he was disappointed by the outcome but pointed to the fact that “a third of BMA members didn’t vote at all”.

Despite a national tour in which junior doctors and medical students were provided with the full details of the new contract by BMA representatives, frontline medics are understood to have been unwilling to sign up to a contract that would require more seven-day working, without a commensurate increase in NHS funding and a promise of staffing increases to fill widespread rota gaps.

There were also concerns over a lack of protection for junior doctors who act as whistleblowers and fears that the new contract would open up a new gender pay gap in the NHS, because of the way it disadvantages doctors who take time out – a measure that predominately affects women who take maternity leave.

The vote will be hugely problematic for both Mr Hunt and the BMA. The outcome will be discussed by the union’s junior doctor committee at its next meeting. It is understood the result is not binding on the BMA but decisions about any further action to challenge the Government over its contract offer will await the appointment of Dr Malawana’s successor, expected in September.

The rejection of the terms of the contract by grassroots junior doctors will cause difficulties for the Health Secretary, who has argued throughout the dispute that BMA was either misleading or radicalising junior doctors. Now, even with the BMA’s backing around new pay structures, junior doctors appear to have rejected the contract because of safety fears and concerns that the NHS is not getting the funding it requires.

In a statement today, Dr Malwana said the Government and the BMA would have to “look again” at the contract and urged NHS trusts not to continue the transition to the new contract, which is already well underway.

Writing to Mr Hunt to confirm the result, Dr Malawana said: “Junior doctors clearly still have major reservations that the contract will adversely affect their working lives, their patients and future delivery of care in the NHS. Against this backdrop it would be wrong for the Government to press ahead with imposition and I hope that you will now engage with further meaningful talks.”

Responding to the result, Mr Hunt said: “It is extremely disappointing that junior doctors have voted against this contract, which was agreed with and endorsed by the leader of the BMA Junior Doctors’ Committee and supported by senior NHS leaders.

“The BMA’s figures show that only 40 per cent of those eligible actually voted against this contract, and a third of BMA members didn’t vote at all. We will now consider the outcome.”

Danny Mortimer, chief executive of the NHS Employers that negotiated the contract on behalf of the government, said: “I am profoundly disappointed the BMA has rejected the proposed new contract for junior doctors. It is imperative that patients will not be made to suffer any further impact as a result of the rejection of the contract.”

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