Nurses have voted to reject their NHS pay deal in a move that could lead to more strike action.

The Royal College of Nursing confirmed 91% of its members who voted rejected the 3.6% pay rise they have been granted for 2025/26. Nurses are furious that for the second year running they have been given less than resident doctors, who have been awarded 5.4% but still went on strike recently. President Professor Nicola Ranger previously labelled it “grotesque” that nurses were again being awarded less than doctors. It comes after doctorssuggested their strikes could last more than six months.

Professor Ranger said: “My profession feels deeply undervalued and that is why record numbers are telling the government to wake up, sense the urgency here and do what’s right by them and by patients.

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"Record numbers have delivered this verdict on a broken system that holds back nursing pay and careers and hampers the NHS.”

The vote to reject the pay offer included nurses in England, Wales and Northern Ireland on a 56% turnout. The legal minimum in any follow-up vote over whether to strike is 50%.

The RCN said 170,000 nurses voted in its ballot in England, its highest ever, and is demanding ministers use the summer to reach a deal. Without an improved deal it will escalate to a dispute and an industrial action ballot which could see nurses strike in Autumn.

It comes shortly after a five-day strike by resident doctors which is expected to have caused thousands of cancelled appointments. Details on the number of appointments, procedures and operations postponed are expected to be published later today(THUR).

NHS leaders fear that Mr Streeting could face a full-scale NHS rebellion after other health unions also rejected their pay deals. The Unite union, which has members in almost all NHS professions, and GMB, which represents staff including ambulance workers, have both rejected the 3.6% pay deal in recent weeks.

Most NHS staff on the main Agenda for Change contract - which excludes doctors and dentists - have been awarded a 3.6% increase for 2025/26. This uplift was recommended by the NHS Pay Review Body (NHSPRB) based on evidence submitted by the government, employers and unions. However unions have questioned the impartiality of the pay review body.

The current annual inflation rate for the Retail Price Index (RPI) in the UK is 4.4%. The latest UK Consumer Price Index (CPI) inflation rate - which excludes mortgage costs - is 3.6%.

The RCN is understood to be open to talks on wider pay structures and quicker career progression, not just headline pay. The union says the pay banding in the Agenda for Change system unfairly traps nurses in lower bands, in some cases for their whole careers.

Prof Ranger added: “As a safety-critical profession, keeping hold of experienced nursing staff is fundamentally a safety issue and key to the government’s own vision for the NHS. Long-overdue reforms to nursing career progression and the NHS pay structure aren’t just about fairness and equity but are critical for patient safety.

“We deliver the vast majority of care in every service and deserve to be valued for all our skill, knowledge and experience. To avoid formal escalation, the government must be true to its word and negotiate on reforms of the outdated pay structure which traps nursing staff at the same band their entire career.”

Professor Ranger’s predecessor Pat Cullen had led RCN members into the biggest strike in the union’s history in December 2022, when around 100,000 nurses walked out. But she came under huge pressure after her leadership recommended members accept a 5% pay rise for 2023/24, plus a lump sum of at least £1,655, at a time of soaring double-digit inflation.

A faction within the union - known as NHS Workers Say No - successfully led a push to vote the deal down, which members did by 54% to 46%. It was seen as a strategic failure by Prof Cullen because it was followed by a second RCN ballot to continue strikes but this failed to meet the legal turnout threshold of 50%.

It was felt that Prof Cullen had failed to explain to members why she wanted to go back on strike over a deal she helped negotiate and nurses were left angry at receiving another below-inflation pay award for 2023/24. In contrast resident doctors - who remained out on strike right up until the General Election - eventually received a 22.3% pay rise over two years including 2023/24 and 2024/25.

A spokesman for the Department of Health and Social Care said: “After receiving two above inflation pay rises from this Government, new full-time nurses will earn £30,000 in basic pay for the first time this year so it’s disappointing that RCN members are dissatisfied with this year’s pay rise.

“This Government is clear we can’t move any further on headline pay but will work with the RCN to improve their major concerns, including pay structure reform, concerns on career progression and wider working conditions.”

Mr Streeting is expected to restart talks with the British Medical Association early next week to avert further strikes by resident doctors. Their unanimous vote to strike - on a 55% turnout - means the BMA’s resident doctors committee has a legal mandate to organise strikes until January 2025.

The Government is adamant it cannot increase headline pay but could find other solutions such as reduced doctor training costs and improved working conditions. Doctors are demanding a commitment to return to 2008 levels of pay, saying they will accept this over a number of years. The BMA argues that by the RPI Measure of inflation resident doctors’ real terms salaries are down a fifth since then.