Hospital consultants look set to take the first industrial action in their history in a showdown with the Government over a new pay deal vital to reform of the NHS.
At their annual conference yesterday, the British Medical Association's consultants voted overwhelmingly in favour of a ballot on industrial action unless ministers offer to renegotiate their contracts.
The threat of strike action sent relations between the Government and Britain's 25,000 most senior doctors plunging to a new low. Within an hour of the vote, the indomitable new Secretary of State for Health, Dr John Reid, issued a statement saying he saw "no need" for the deal to be restructured.
The new contracts offer pay rises of up to 20 per cent depending on increased productivity and bonuses. But the doctors rejected the deal last year, fearing they would have to hand too much control over their hours to managers.
While an all-out strike is a possibility, consultants are more likely to stage overtime bans and a work to rule. But even limited industrial action could hobble the NHS.
At the conference in London, consultants warned that industrial action would be "disastrous" for the NHS and could scupper reform of the service.
Dr Simon Miller, chairman of the BMA's Consultants Committee, said: "Consultants are desperate and angry. We want to talk to Dr Reid and try to resolve our differences, but we are prepared to take industrial action to defend the NHS."
Consultants currently work an average of 29 hours a week over and above their contracts, and it is estimated that up to a quarter of all NHS activity is performed by consultants on overtime.
Dr Miller said that consultants would work to protect "emergency and acutely ill patients" from the effects of industrial action. But non-urgent patients would be hit, with waiting lists inevitably rising if consultants work to rule.
If no deal is brokered, consultants could be balloted within the next few months. Industrial action could then start during the winter months - when the NHS is already beset by seasonal pressures. The consultants have threatened industrial action only once before, in the 1975 dispute over pay, but have never taken it.
The contract reforms have reached an impasse after the consultants rejected last year a deal thrashed out between the Government and BMA negotiators. Consultants have objected to clauses that would give hospital managers more control over their hours and restrict newly-qualified doctors from doing private work.
They also want written assurances that they will not be forced to perform routine surgery at evenings and weekends. They had hoped that the appointment of Dr Reid would open the way for new talks on their contracts, after they rejected the proposed reforms last year.
Alan Milburn, the former Secretary of State for Health, had steadfastly refused to reopen talks after the "no" vote and had tried to implement the deal locally.
But issuing a statement in response to the BMA vote, Dr Reid said: "I have looked carefully at the offer made to consultants ... and I see no reason to renegotiate that generous deal."
The results of a ballot on new contracts for GPs will also be announced today. Family doctors are expected to accept government proposals which will link their pay more closely to performance.