Doctors voted on Thursday to ramp up their pensions dispute with more industrial action that threatens to reduce the NHS to a bank holiday-style service, dealong only with emergency cases.
Most of the 500 delegates at the British Medical Association's annual conference backed a motion calling for doctors across the UK to escalate the industrial action, a week after protests that deprived tens of thousands of patients of a planned operation or appointment with specialists or GPs.
However, there is some tentative optimism among BMA leaders that a resolution to the year-long dispute could soon emerge from behind-the-scenes talks.
Delegates agreed that more industrial action was necessary to try to force ministers to backtrack on pension arrangements that have infuriated the profession because they will force doctors to work until they are 68, pay more to pension contributions and forfeit their final salary scheme.
The BMA motion said any future action "should be in conjunction with other public sector unions" and that the ruling council of the medical union "should consider a range of options in defence of our pensions".
The options included a withdrawal from the establishment of clinical commissioning groups, bodies that will become key in the NHS in England under the coalition's controversial health reforms.
In secondary hospital care, the option is for "withdrawal of labour with emergency cover only". Such a move would mean the NHS being able to offer only a minimal service, similar to that given on Christmas Day or bank holidays when staff deal only with emergency cases.
The move does not bind the BMA's council, which will discuss what steps the union should take on Friday afternoon.
The motion was passed despite warnings from delegates, including Ivan Camphor, a GP who said doctors would risk losing patients' goodwill by taking further action.
Kevin O'Kane, a London hospital consultant, who proposed the motion with Anna Athow, a council member, said the move would show the health secretary, Andrew Lansley, that doctors would fight – by taking several further days of action, if necessary – until they received fair treatment over their pensions.
O'Kane, who chairs the BMA's 32,000-strong London region, told the gathering in Bournemouth: "We need to send out a very strong message to the government that we are serious about this, and get another day of action on the books. Let's get more days of action announced and get some momentum around this. Mr Lansley, we are very serious about this and you had better believe it."
But the conference rejected a part of the motion calling on the BMA council to name a date for a second day of action. That rejection could have heeded the advice of the BMA's outgoing chairman, Hamish Meldrum, who just before the vote advised against support.
Meldrum, who this week warned doctors that further action would damage patients' trust in them, indicated to delegates that there might be an announcement soon about progress on breaking the deadlock. A lot of discussions had been held since last week's day of action and there could be some news soon, he said.
Making his final address to the BMA after leading the 140,000-strong organisation for five years, Meldrum said it might "not be wonderful that things go back to 2008 [when the BMA agreed a pensions deal with the Labour government]", but that there might be developments.
On Monday, Meldrum hinted thatdoctors might be persuaded to call off the dispute if ministers agreed to concessions over two key concerns:
• Doctors having to carry on in their jobs until they are 68, which, some say, will be impractical for A&E doctors and certain categories of surgeons. .
• The planned increases in doctors' pension contributions that are due to happen in 2013 and 2014.
However, Department of Health sources confirmed that while the detail of those two issues was still to be agreed, doctors would receive no concessions in response to taking, or threatening to take, industrial action.
A letter sent by Lansley on Wednesday to Christina McAnea, Unison's head of health, who is co-ordinating the opposition of 15 health unions to the pension plans, indicated there could be scope for agreement on the two issues identified by Meldrum.
Lansley wrote: "We also need to discuss contribution rate increases in years two and three and how this will feed through in tiered contribution rates. This work needs to be taken forward in a spirit of partnership focussed on achieving pension arrangements that will best meet the needs of staff and employers."
In another seemingly emollient passage, he said: "I recognise that trade unions are particularly concerned about the increase in normal pension age. The implications of this will be considered in the Review of Working Longer, and the government has also committed to keep the link under review as recommended by Lord Hutton."
Sources involved in the dispute suggested that, as part of a potential resolution to the dispute, certain sorts of doctors might be able to do less onerous tasks than usual when they reached their mid-60s.
Lansley's letter also made clear that he would be pressing ahead with implementing the shake-up of the NHS pensions scheme, partly because "the majority of NHS staff" had not rejected the proposals in a series of votes – that often had low turnouts – which had been held by unions including Unison, Unite, the Royal College of Nursing, and the Royal College of Midwives The Guardian
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