Junior doctors and medical students who are members of the British Medical Association (BMA) have voted against a new contract hailed just weeks ago by health secretary Jeremy Hunt as a "significant step forward".
The government and the BMA reached an agreement over a new contract in May after back-to-back talks at conciliation service Acas. The main changes the union agreed to at the time were that basic pay rise was to be reduced from 13.5% to between 10% and 11%, weekend pay structure was changed and a reduction in pay for night shifts.
But around 58% of the BMA's 40,000 members rejected the offer by a margin of 58% to 42%. The result led to the resignation of the union's junior doctor Johann Malawana after he felt it would be "dishonourable and untenable" to remain in the post.
In a letter to members, he said that he hoped the contract agreed in May "would be acceptable to our amazing membership", before blaming the government for its capitulation.
"However, I believe the fundamental breakdown in trust caused by the government's actions over the last five years has resulted in a situation where no solution is possible, particularly when a government is so keen to declare victory over front line staff."
The result means doctors and students risk having the contract imposed on them, a move that will likely spark industrial action similar to the historic all-out strike in April.