The government has come under fire following the decision by senior hospital doctors to reject new working arrangements.

Opposition parties said the no vote reflected consultants' lack of trust in managers and the government.

However, NHS managers said they were disappointed with the vote describing it as a "missed opportunity".

Ministers have only themselves to blame for this result

Shadow Health Secretary Dr Liam Fox

Consultants voted almost two to one against the new deal with many saying it gave managers too much power and threatened their independence.

It was backed by doctors in Scotland and Northern Ireland but rejected by doctors in England and Wales.

Political row

Shadow Health Secretary Dr Liam Fox said government policies on the NHS were to blame.

"Ministers have only themselves to blame for this result. Alan Milburn must carry the can for the damage which it causes.

"Doctors have rejected the contract because they fear - understandably and rightly - that ministers are determined to undermine their clinical judgment even further."

He added: "It is a great pity because the contract had much to commend it that will now be lost - greater transparency and accountability for a start, concepts which I know appeal to many doctors.

"Patients might also have benefited from more convenient and expanded treatment times."

Liberal Democrat health spokesman Dr Evan Harris said: "This is a shattering blow to what's left of Labour's medical workforce strategy.

The no vote is a missed opportunity to take forward a win-win offer

Gill Morgan, NHS Confederation

"The rejection is not about pay - the settlement would have been generous. It was a refusal to give ministers and managers even more control of NHS decisions in an over centralised service."

He added: "This vote shows the depth of medical opposition to government policy and the extent of the suspicion of ministers' motives. The government's workforce strategy is clearly in tatters."

Managers disappointed

However, Gill Morgan, chief executive of the NHS Confederation which represents NHS managers, said she was disappointed with the result.

"The no vote is a missed opportunity to take forward a win-win offer, which would have enabled consultants' NHS work to be properly rewarded, allowed managers to more effectively plan services, and provided patients with more convenient care.

Ms Manero criticised the result

"The issues raised by the BMA seem to indicate that consultants have real concerns about being managed.

"However, to deliver a modern health service which meets the needs of patients, it is essential that the work of doctors is effectively planned and managed.

"This means it is less possible for doctors to be as independent and autonomous as they've been in the past."

Stuart Marples, chief executive of the Institute of Healthcare Management said: "The proposals would have been good for everyone - consultants, managers and above all patients.

"We thought the proposals gave a good balance to clinical freedoms and legitimate management interests."

He added: "Overall though, this is not about the relationship between managers and doctors, it is about doctors, a new contract and new ways of working."

Patient groups also criticised the vote.

Elizabeth Manero, chair of London Health Watch said: "This is a disappointing day for patients."

She urged managers and doctors to work together to find a solution.

Mike Stone, chief executive of the Patients' Association, urged the government to re-enter talks with the BMA to agree a new contract for consultants.

Mike Hall, chief executive of Standard Life Healthcare which sells private insurance cover, welcomed the vote.

'Today's result is good news for consumer choice," he said.

"A consultant's capacity for undertaking private work would have been severely restricted under the proposed contract."