National Health Service managers have been told to draw up contingency plans to deal with the threat of the first-ever strike by doctors in England, which could take place within two months.
The British Medical Association is to ballot members over possible industrial action against the Government's proposed changes to doctors' pension entitlements next month.
If they vote in favour of a 24-hour strike, doctors would only provide urgent and emergency care to patients. Routine operations, scheduled GP appointment and hospital outpatient appointments would be cancelled. The BMA has said it will review the "impact on patients of the day of action" but further one-day stoppages are likely. As a result, NHS executives are being told to draw up plans for dealing with the knock-on effects of a walkout, as well identifying what is and what is not urgent or emergency care.
"We need to work out what happens in areas like cancer treatment and appointments," said a source at the Department of Health. "If appointments have to be rescheduled, how long will that take and who will decide what is and what is not urgent,"
The BMA said "patient safety" would be its priority and striking doctors would be present in workplaces so that urgent care was provided. Decisions about what could safely be postponed would be based on the professional judgement of doctors locally, it added.
The strike ballot is the latest sign of the increasingly hard line being taken by the BMA in its opposition to the Health Bill. But some doctors fear that threatening to strike over the issue of retirement provision – when doctors have some of the most generous pensions in the public sector – could prove counter-productive.
The Government claims that a typical full-time consultant retiring at 60 currently receives a pension of more than £48,000 a year for life, plus a tax free-lump sum of about £143,000. Under its new scheme, a 40-year-old consultant would need only to work for an extra two-and-a-half years to get the same pension and lump sum.
However, the BMA says that, under the proposals, doctors' pension contributions would double and they would have to work until they were 68. It points out that the NHS pension scheme underwent a major overhaul in 2008 to ensure it was sustainable, and it now provides a positive cashflow to the Treasury of £2bn.
Both sides, at this stage, appear unwilling to back down. Privately, ministers are not unhappy about picking a fight with the BMA over pensions as they believe public sympathy for any strike action would be limited. At the same time, senior BMA figures are under pressure from grassroots members to take a tough line. An election to replace Hamish Meldrum, the chairman of the BMA Council since 2007, is due to take place in June. Candidates to succeed him have been careful not to appear too conciliatory towards the Government.