Tens of thousands of junior doctors in England are to strike for a further four days from Friday. The action is the fifth round of industrial action and the first since a five-day stoppage was held last month from July 13.

The British Medical Association (BMA) members rejected a six percent plus £1,250 consolidated increase pay offer. Last month Prime Minister Rishi Sunak declared that the well below inflation offer was “final”.

The doctors have a powerful place in society, playing a critical role as part of the 1.3 million strong National Health Service (NHS) workforce. Their strikes, along with previous stoppages by other NHS staff since December have resulted in 835,000 cancelled operations and appointments. But the NHS Confed has reported “senior operations managers say this is the tip of the iceberg, with the official figures only recording cancellations on the day. NHS trusts now routinely pre-empt the strikes by not filling slots that could otherwise be used for elective activity.”

The leadership of the junior doctors say they are not backing down on their call for pay to be restored, after a 15-year period which has seen pay decline in real terms by 26.1 percent. The BMA called for a 35 percent increase at the outset of the dispute, noting that a barista at Pret Manger made £14.10 an hour while a junior doctor earns £14.09.

The junior doctors are also being balloted to extend their six-month mandate for industrial action, as required under anti-strike legislation. The ballot closes August 31.

Junior doctors have waged a determined fight, but by itself this is not enough to secure victory. Neither is it enough to wage a campaign directed solely at a hated Conservative government set on the destruction of the NHS.

Junior doctors are striking alone after every other strike in the NHS, aside from senior consultants and radiographers, has already been sold out—with the union bureaucracy accepting rotten deals for workers making up the bulk of the NHS workforce in May and June.

The reality behind Sunak’s bravado in facing down junior doctors is that his crisis-ridden government wouldn’t have survived the massive strike wave that erupted over the last year without the trade union bureaucracy sabotaging one dispute after another in alliance with their partners in the Labour Party leadership.

Their treachery has seen the defeat of nurses and ambulance crews among the million workers on Agenda for Change contracts. Along with these is the ending of disputes by the union bureaucrats of hundreds of thousands of workers in Royal Mail, on the railways, and in schools, universities and colleges.

The current leadership of the junior doctors was elected on the crest of a wave of anger over the attacks junior doctors have suffered since the BMA’s betrayal of their months long strike in 2016.

Speaking at a demonstration in Trafalgar Square in April, Dr. Arjan Singh of the BMA’s junior doctor committee (JDC) told the rally, “Your union will back you to the hilt. We will not sell you out… To the registrars here, this is a new BMA and this is not 2016. This is a BMA that is unashamedly pro-doctor and for you.”

Yet throughout the dispute, the one thing that the BMA junior doctors’ leadership has never raised is the necessity for a fight to defeat the stranglehold of the union bureaucracy over NHS workers and the entire working class. Every doctor knows that winning a 35 percent pay increase and restoring doctors’ pay cannot be won outside of a massive battle that cannot be waged in isolation from other workers. But they are being isolated—by the BMA, the Royal College of Nursing, Unite, Unison and the rest.

Moreover, this fight is not simply about the here and now, as the Tory government continues its offensive eviscerating the health service and carrying out further privatisation measures. There will be no let-up under any Labour government should it come to power. Party leader Sir Keir Starmer has declared that the “big government chequebook” will be closed and Shadow Health Secretary Wes Streeting denounced health workers as “obstacles” to the “unsentimental reform” of the NHS required, boasting, “We are not going to have a something-for-nothing culture in the NHS with Labour… I’m not prepared to pour money into a black hole.”

The BMA Junior Doctors Committee offers no means to fight this conspiracy between the Tories, Labour and the trade union bureaucracy. On July 24, JDC leaders Dr. Robert Laurenson and Vivek Trivedi gave a joint statement at the BMA headquarters declaring of the strike mandate ballot, “It's not uncommon for unions to fail to meet the threshold set by the government to renew a mandate for strike action. In the last few months, we’ve seen it happen to teachers. We’ve seen it happen to nurses.”

This deliberately obscures the critical issues in those struggles. In the teachers and nurses disputes, as well as that of the postal workers, workers accepted bad deals as a vote of no confidence in their union’s leadership after sporadic strike action was stretched out over months with no perspective for victory.

Junior doctors cannot adopt a “wait and see” approach as to what the bureaucracy, including the JDC, will do. There must be a fight for the formation of rank-and-file committees in every hospital and NHS facility, operating independently of the union bureaucracy. These committees must become the means for doctors to expand the strike to include all doctors and other health workers in a common struggle against low pay and the destruction of the NHS.

Central to the doctors’ fight is the elaboration of a socialist strategy to defend the NHS and the right to public health care.

With Britain embroiled in an expanding global economic crisis, amid an escalating war now focused on NATO’s de facto conflict with Russia in Ukraine, the ruling elites everywhere have declared that pouring billions into essential health, education and welfare spending must stop. Only a few months ago, the Royal United Services Institute (RUSI) think-tank said of a Tory pledge to spend £150 billion more on the military in the next eight years that it would mark “the end of the peace dividend.”

RUSI complained that “Since the mid-1950s, the UK has been able to fund the growing share of its national income devoted to the NHS and state pensions through cuts in the GDP share spent on defence.” This was no longer possible as defence spending had to uplifted from “famine to feast” levels.

This is why the doctors struggle cannot be understood as or fought on a national basis, but requires the adoption of an international and anti-capitalist strategy. We urge striking doctors to contact NHS FightBack today to discuss these vital issues. NHS FightBack’s Facebook page is here and Twitter here.