I have been a doctor for over 36 years. As a vascular surgeon in Cheshire I see patients from a wide variety of backgrounds, and for me one of the finest aspects of our NHS is that patients are referred to me regardless of their financial status.

Of course the NHS has changed tremendously since I qualified and many of those changes are for the better. With the help of new medical technologies, powerful drugs and new surgical techniques, people are living longer and their expectations from doctors have never been higher.

I doubt that Aneurin Bevan would recognise today’s health service: it is a huge, monolithic body that employs more than 1m people and on average about 48m patients have contact with the NHS every year. The government has invested unprecedented funds in the NHS and some parts of the service are getting better. Waiting lists are a good example and — it is important to say so — it is not all doom and gloom.

However, all over the country, doctors are seriously worried about where the NHS is going. This was very clear last week at the British Medical Association’s annual meeting in Belfast. Feelings ran very high and clinicians including GPs, junior doctors and consultants are demanding that healthcare should be delivered by providers that are accountable to patients, not shareholders.

News emerged on Friday that the government had been quietly encouraging tenders from the private sector for a wide range of roles in the management and support of primary care trusts: I am concerned that it only seems to be a short step to move from there to clinical services. This must not happen.

The NHS is struggling to manage deficits. Many healthcare professionals are losing their jobs and even some doctors face the risk of redundancy. Given that the UK is critically short of doctors, this does not make any sense.

Last week in Belfast many of my colleagues spoke of their worries regarding cancelled clinics, empty operating theatres and patient referrals diverted to referral management centres.

These centres really worry me. When a GP refers a patient to a certain consultant now, a bureaucrat at a management centre — often not even a trained doctor — reviews the case and has the power to redirect the patient to another consultant’s list. This is ostensibly to make sure patients go to specialists with shorter waiting lists.

But the GP may have chosen a particular consultant for a good reason. Nobody should be able to second-guess the GP.

Doctors are also worried about independent sector treatment centres (ISTCs), set up to provide extra capacity and bring down waiting lists. We stressed to the government that it was extremely important that ISTCs were situated in areas where there was a need for extra capacity, that is, where the hospitals could not cope. Now we hear that ISTCs are receiving guaranteed sums of money even if they do not attract sufficient patients — so private companies are being paid for operations they do not do while NHS hospitals are having to lay off staff because of cash shortages.

No wonder the clinical workforce is up in arms. The BMA is a broad church with doctors from every part of the political spectrum and widely differing views on what to do to save the NHS. What unites us is the will and determination to keep the NHS comprehensive and free to patients, ethically rationed by clinical priority, equitably resourced and funded out of general taxation.

These fundamental values cannot be maintained if the NHS is broken up and tendered to private corporations. This is my vision for the NHS and I’m worried the government is taking us away from that.

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. There is no doubt it works in supermarkets — plenty of choice, good quality and low prices. But will it work in a health service where more “customers” — we doctors are old- fashioned enough to call them patients — do not mean more profit but more cost.

In America, people with health insurance have loads of choice and lots of competition. But is it keeping prices down? No — prices are rocketing. Is it keeping quality high? No — there is more variability in US healthcare than anywhere.

The very last thing the UK should do is go for the American model of healthcare.

I want our NHS to aim higher and I shall be saying just that when I meet the secretary of state for health, Patricia Hewitt, at this week’s “health summit”.

The summit aims to get health professionals and government working together to identify and tackle the problems associated with implementing reform. This week’s meeting will set work in train for a second, much larger such summit later in the year.

Patients also need a voice in the system. The current level of reform in the NHS is relentless and despite all the talk of “choice” it is very rare that we actually hear what patients want. According to a Mori poll, the public are becoming increasingly sceptical and dispirited about the health service. Their expectations of it have plummeted by 32% since the May 2005 general election; 45% of people now expect NHS services to get worse in the new few years.

In my vision for the NHS there needs to be more focus on emergency care and the improvement of long-term conditions. There is a real danger that improving the lives of those coping with long-term conditions is being forgotten, as politicians do not see how this fits in with a “production line” policy of see and treat. Some people are ill for most of their lives and need constant monitoring — ISTCs will not help them.

My plea to government — one I shall make very clearly at the health summit — is to involve doctors in decisions at all levels. Many doctors are natural innovators but have become distanced from the running of the health service. I believe the only way to stop the rot is by clinicians becoming involved in every aspect of managing, running and shaping the NHS.

James Johnson is chairman of the British Medical Association