Instead of GPs holding 24-hour responsibility for their patients, out- of-hours work should be separated entirely from "in-hours" or daytime work, their national conference demanded. GPs would then chose which contract they wanted to hold - day cover, night cover or both - with health authorities responsible for providing cover at night where GPs chose not to do that.
The move raises the possibility that the Government could retaliate by encouraging private companies to provide night cover, hiring their own doctors to do the work.
The decision was described as "momentous" by Dr Ian Bogle, the family doctors' negotiator.
It was the most dramatic by GPs since the 1960s and would require an entirely new contract to that imposed by the Government in 1990, he said.
Virginia Bottomley, Secretary of State for Health, urged GPs to think again, saying it would be "a very, very sad day for the National Health Service" if family doctors opted out of their 24-hour responsibility for patients.
The call to draw up such proposals came as the conference of local medical committees, meeting in London, took a key step closer to industrial action in its dispute with the Government over out-of-hours work.
As it voted for a ballot on industrial action, Dr Bogle said he would seek a meeting first with Mrs Bottomley and then with John Major before a final decision next month. But after health ministers' insistence that their offer is final, Dr Bogle said "you need to be supremely optimistic to think we are going to get any great joy".
Fury at the failure to find a solution to a mounting daytime workload and ever rising demands at night was palpable at the conference as GPs protested that they could not continue burning the candle at both ends.
Dr Brian Hope, of Salford, said 24-hour care was "an old concept that has outlived its usefulness". It was "ridiculous" that GPs received pounds 2,500 for a year's night work. "Not many Tory MPs would leave their lover's beds for that sort of money. Though they might do in one instance - if it was to ask a Parliamentary question".
GPs protested they were working more than 100 hours a week - longer than junior hospital doctors but with the prospect of doing that for 30 years. Dr Barbara West, from Glasgow, said that led "to alcoholism, divorce and burn out. Our young doctors see that, and they simply won't do it."
Chris Tiarks, a Scottish GP, warned that any form of sanctions would damage patients - a charge Dr Bogle denied. Shots in the GPs' locker are believed to include unfettered referral of patients to hospital, prescribing expensive rather than generic drugs and hitting NHS paperwork. Ministers will argue, however, that the resulting higher costs will mean less cash to treat other patients.
Dr Bogle said ministers had shown themselves willing to "talk, talk and talk" but not act.Reuse content