The leader of Britain’s doctors gave warning yesterday that there is only one year left to save the NHS before the Government will seriously question whether it can continue in its current form.

James Johnson, the chairman of the British Medical Association, said that more questions would be asked about whether the NHS could continue to provide everything, or whether a system may need to be introduced where people paid towards their treatment.

He said that the current financial deficit coupled with the end of the current spending round this year would mean that ministers would “look very carefully” at what should happen next.

Mr Johnson said: “Don’t assume there’s anything automatic about the system we have at the moment continuing into perpetuity. If you get 9 per cent of GDP spent on health and you still can’t make it work, people will be saying, ‘Do you want to carry on doing the same thing or should we be trying something fundamentally different?’ ”

He gave warning that poor workforce planning may force doctors to go abroad for work, adding that he knew of at least 50 orthopaedic surgeons who would not be able to get jobs in Britain by the end of the year.

Last week a leaked Department of Health document predicted an excess of more than 3,000 consultants in the NHS by 2010-11 that the service could not afford to pay.

Mr Johnson said it was a “disastrous waste of public money” to train doctors only for them to go overseas. He added that he was very worried that the public health system was “going down the tubes”.

Mr Johnson said a reconfiguration of primary care trusts and strategic health authorities had caused about half of the heads of public health to lose their jobs.

While they may be able to find positions once things had settled, he said that there was still concern over the future of the system. Mr Johnson said what had happened was “extremely disheartening”, adding: “Unravelling the public health system in this country is perhaps one of the most short-sighted things any Government can do.

“I’m very worried indeed that it’s just going down the tubes.”

Mr Johnson also said that the NHS was “heading for the buffers” over staff planning, which needed to be addressed “urgently”.

A spokesman for the Department of Health said: “We are fully committed to a publicly funded NHS that delivers healthcare according to clinical need, not ability to pay.”