In a move that threatens to deepen the Health Secretary's difficulties over the closure of London hospitals, leaders of the British Medical Association called a meeting for 20 April to consider balloting GPs about action.
The action, including more referrals to hospitals and the prescription of more expensive drugs, would be aimed at hitting Treasury spending limits without harming patients.
The dispute deepened last night after the failure of talks with Gerry Malone, the Minister of State for Health, to reach agreement over demands for more money for night visits. The GPs have rejected £2,000 a year and £9 per night call, with an extra £15m if they form co- operatives.
The presentational problems of Mrs Bottomley's announcement over the London closures were underlined yesterday when it emerged that John Redwood, the Secretary of State for Wales, checked his speech opposing a local closure in Wales, he was not told by the Health Department that the London announcement was imminent.
On doctor's night cover, Mr Malone last night offered them more flexibility over how the package was paid out. He said he was prepared to rethink his offer and put new figures next week to avert the threat of action.
A BMA spokesman said: "The lack of substance in this offer threatens the future of the GP out of hours service in a week when the Secretary of State announced plans to close accident and emergency units."
The action was threatened after David Mellor, the former health minister, warned that the NHS in London was facing "a crisis of confidence at every level" and Mrs Bottomley needed to get a grip on it.
Mrs Bottomley was given a show of support by John Major and the Cabinet after she reported to the Cabinet on her Commons statement on the hospital closures in London.
Meanwhile, the Cabinet sought to lift its sights beyond its continuing difficulties over the NHS by preparing an attack on what ministers claim is a rare but serious "strategic error" by Tony Blair, the Labour leader, in maintaining a pro-European stance while admitting that public opinion had swung towards scepticism.
After the weekly Cabinet lasting 90 minutes, it held a lengthy discussion about the relaunch of the party's policies led by the Prime Minister at last week's Tory conference in Birmingham.
Douglas Hurd, the Foreign Secretary, was said to have told the meeting that Mr Blair had been "footloose" with Britain's veto in the EU in ways that he would come to regret.
But in an interview with the Independent, Mr Heseltine reinforced his own commitment to Europe by saying that his views on the subject "have not changed since I was at university". He says that public opinion on the subject is "fickle" and "always changing". Mr Blair said in his speech at Chatham House on Wednesday that Labour's present position on Europe was "several shades milder" than that of Mr Heseltine's in the late Eighties". In a further problem for Mr Major, the Government was bracing itself for a severe beating in the Scottish local elections. As polling drew to a close, the turnout levels were difficult to assess, but no one was predicting a heavy turnout. The Conservatives face the prospect of heavy losses as the votes were being counted in the elections to Scotland's 29 new all- purpose councils.
Andrew Marr meets Michael Heseltine, page 19Reuse content