Delegates made plain their opposition to a whole range of reforms in a series of debates that discomfited the BMA’s leadership — including what amounted to a vote of no confidence. A government that was welcomed by doctors when it came to office in 1997, and has spent unprecedented amounts on the NHS, thus finds itself lacking medical support.

Speaker after speaker charged Tony Blair’s Government with incompetence, muddle, rushed and ill-considered reforms, and a secret desire to break up and privatise the NHS. The conference agreed to back the campaign group Keep Our NHS Public and only narrowly declined formal affiliation.

The group anathematises private involvement in the NHS, seeing healthcare as a public service that can only be delivered by public servants.

The conference, which is the BMA’s policymaking body, also passed by a clear majority a resolution that declared the BMA leadership had failed “patients, the profession and the country by their failure to actively oppose the current wave of organisational and financial reforms which are destabilising the NHS”.

The leadership defended its engagement with the Government, saying that to influence policy it needed to be in regular contact, but delegates passed the motion by a 58 to 42 per cent vote — a sharp and unexpected reverse. Moving the no-confidence motion, Natasha Arnold, from Islington, North London, said there was “a real and imminent danger to the future of the NHS”.

Earlier, one of the leaders of Keep Our NHS Public, Jacky Davis, said that the Government increasingly saw the NHS as no more than a “kitemarking”, or rubber-stamping, organisation that would certify treatments delivered by others.

Sir Alexander Macara, a former BMA chairman, said of the Government: “As well as providing new resources, it has introduced cavalier and ill-founded reforms based on an arrogant belief in the rectitude of its own theories. We must say to the Government, ‘Get on the right planet and listen to doctors’. We must ask the Government to have the courage and humility to say, halt.”

This seems very unlikely, at least while Mr Blair remains at No 10. For him, reform is not fast enough. He believes that to improve efficiency and productivity the service has to endure some pain, and is likely to see yesterday’s debates as evidence that this is happening.

Earlier, James Johnson, chairman of the BMA Council, had criticised the “breakneck pace and incoherent planning” of the NHS reforms, which include patient choice, payment by results, and practice-based commissioning.

Payment by results aims to pay hospitals per item of service, a policy likely to encourage them to do more and suck in huge amounts of NHS money. To counteract this, practice-based commissioning aims to put the power over money in the hands of GPs, who will want to retain as much of it as they can in primary care.

In theory, the two policies should create a pseudo-market that drives efficiency and shifts care out of expensive hospitals and into affordable primary care. But the policy has the air of having been assembled hurriedly.

“The NHS is in danger and doctors have been marginalised,” Mr Johnson said. “Everyone is telling the Government: you must get the professions on board; you must involve clinical staff; you can’t make this work without doctors.

“The Government’s favoured method of raising quality and keeping prices down is to do what they do in supermarkets and offer choice and competition,” he said.

“But will it work in a health service? More ‘customers’ — we doctors are old-fashioned enough to call them patients — does not mean profit, it means more costs.”

Mr Johnson’s call for a line to be drawn in the sand was well received, but delegates had come to the meeting determined to give him and the rest of the BMA leadership a bloody nose, which they duly did two hours later.

The Government can expect a more combative BMA, but may not mind. To it, how doctors behave is part of the problem, not part of the solution.

The question is whether any health service can be delivered efficiently by a disaffected and truculent workforce.

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