In his first interview as president of the Royal College of Surgeons, Bernie Ribeiro warned that the NHS will not be able to survive on central funding, and that patients should pay for part of their treatment as they do in France and Germany.

"If we are to provide health care free at the point of need all the time for patients, then I don't think that's achievable in the present structure," he said. "We will have to look hard at an alternative system."

His controversial proposal was rejected by doctors' leaders and health service workers' representatives.

The Chancellor, Gordon Brown, ruled out any move away from a tax-funded NHS following a recent review.

The shadow Health Secretary, Andrew Lansley, today said that it was not necessary to abandon the concept of a tax-funded NHS.

However, Mr Ribeiro's remarks will provide powerful ammunition for Conservatives, who want to argue for fundamental reform of the current system.

He insists that rapidly changing technology, drugs and staffing costs mean that the status quo is unsustainable. A means-tested system, exempting the poorest from charges, could actually bring more money into the health service, he said.

"We're not a poor country, the working population is reasonably well paid.

"We could afford our workers to make an identifiable contribution towards health care - not one that's hidden in national insurance and taxation.

"I think that the public would be prepared to pay. It's a question of how you structure it. We seriously need to look at this again."

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