The British Medical Association is to hold an emergency meeting next month after its council bowed to grassroots pressure from members angry at its policy of "critical engagement" with the Government over the reforms.
Dr Steve Hajioff, who will chair the meeting as head of the BMA's Representative Body, told the doctors' magazine Pulse: "Absolutely everything about our response and the way we engage could change, with the Bill as a whole and sub-sections. We'll know what members think about competitive tendering, for example, and what they require us to do. That could vary from welcoming something, to doing nothing, to organising a strike ballot. The last is unlikely, but it is possible."
The mood among doctors has darkened in the last month since the Government published its response to the consultation on the White Paper in December, which largely dismissed doctors' criticisms, raising doubts over the BMA's "engagement" strategy.
The threat of outright confrontation grew this week with publication of a poll of almost 2,000 members of the Royal College of GPs showing almost two-thirds opposed the reforms. An earlier survey by the King's Fund, the health policy think-tank, found that fewer than one doctor in four believes the reforms will improve patient care, and regular polls by Pulse have shown opposition rising as more details have emerged. Two leading medical journals entered the fray this week with editorials warning of "damage to patient care" (British Medical Journal), and "the end of the NHS" (Lancet).
The growing unrest will alarm ministers who know that the changes cannot be implemented without the co-operation of doctors. David Cameron, the Prime Minister, said on Monday that without modernisation the NHS would become unaffordable. But he admitted that his own brother-in-law, a cardiologist in Basingstoke, had doubts.
The chief area of contention is over what GP leaders describe as the "competition agenda": moves to encourage the private sector to compete to run NHS services – which they say will create a more expensive and inequitable market-based system. They are demanding that ministers scrap moves to force hospitals to compete on price.
Last month, an open letter to the BMA signed by more than 100 GPs and other doctors accused the association of hastening the pace of the reforms and demanded it "engage more with its own membership". It called on its leaders to "mobilise the profession and stop these damaging reforms, which will not only destroy the NHS but also profoundly affect the social fabric of the nation".
Kambiz Boomla, a GP in Tower Hamlets, east London, and one of the signatories, said: "The BMA wants to avoid a damaging split in the profession. But they see the groundswell of opposition building up. I would like to see the BMA mounting a campaign.
"Doctors' personal self-interest is to engage with the reforms. But this is about maintaining equity and public service principles rather than market-based health care which always leads to inequitable provision."
Richard Vautrey, deputy chair of the GPs committee of the BMA, said: "The meeting will provide an opportunity for members to consider all options. I don't expect there to be a focus on strike action – you cannot force the NHS in a particular direction without the engagement of clinicians. But it is too simplistic to say we oppose or support everything. We know the grassroots are angry because the Government doesn't appear to be listening. We want them to listen and respond accordingly."
Health Minister Simon Burns said: "We expected resistance from the BMA over our proposals to create a fair playing field to give patients more choice of provider. They have previously opposed this under successive governments."
Doctors' fears for the NHS
Pace and scale of the reforms
The reforms have not been piloted or tested, and implementing them as the NHS is seeking £20bn of savings is "exceptionally crazy", doctors say.
Privatisation and expansion of the market
Doctors fear allowing private organisations to compete to run services will lead to fragmentation and break-up of the NHS.
Price competition
NHS hospitals will be able to cut prices to attract business in what critics have warned will be a "race to the bottom".
Regulation and governance
A fear shared by doctors and ministers is that the vast reform programme, costing billions of pounds, could still leave the NHS unchanged. Everything will depend on how the NHS Board, Monitor, the economic regulator, and the Care Quality Commission manage the new system.
Education and training
Doctors fear the lack of national oversight will leave it fatally damaged.
Putting GPs in charge of the NHS budget
GPs are being given control of almost £80bn of the NHS budget – but do they have the management expertise, or the motivation, to handle it?
The future of public health
After 35 years, responsibility will be handed back to local authorities. There are fears it will be sacrificed by councils searching for cuts.
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