The decision by senior hospital doctors to reject a new contract for consultants has revealed deep divisions within the profession.

Doctors across the UK voted almost two to one against proposals to change the way they work.

However, the vote was split with doctors in England and Wales rejecting the deal and doctors in Scotland and Northern Ireland backing it.

It is not the best day for the BMA

Dr Ian Bogle, BMA

The result has also created serious problems within the British Medical Association, whose leaders had campaigned strongly in favour of the contract.

The BMA's chief negotiator Dr Peter Hawker resigned immediately after the result was announced. Other members of its consultants' committee may follow.

Sharp differences

In addition, the vote revealed sharp differences between existing consultants and those junior doctors who can expect to take up senior posts in the coming years.

They were also asked their views on the proposed contract. Their opposition was even stronger, with five out of six specialist registrars rejecting the package.

The nationwide split has been attributed to the fact that doctors in Scotland and Northern Ireland carry out less private work than their colleagues in the rest of the UK.

BMA chairman Dr Ian Bogle acknowledged that the result had damaged the association.

"It is not the best day for the BMA. I won't pretend to you. If you go out to open ballot, then occasionally you get a result that isn't expected."

He added: "The most important and urgent task is to reconnect with our members and find a way forward that meets their needs and addresses their concerns."

It has divided opinion within the profession

Dr Peter Hawker, BMA

Dr Hawker who had chaired the consultant's committee for four years also acknowledged that the vote had created difficulties.

"There is much that is good in the contract but it has divided opinion within the profession. We now have a major task ahead to tackle their concerns and rebuild a sense of unity."

Renewed hope

Mr Paul Thorpe, chairman of the BMA's junior doctors' committee urged any future talks on a new contract to take the views of specialist registrars into account.

"Specialist registrars have given a clear signal that the contract, as it stood, would have been detrimental to consultants and the NHS as a whole. We hope that a fair deal for present and future consultants will be reached."

He added: "Specialist registrars are the future consultants of the NHS and to ignore such a massive rejection of this contract by them would be folly."

BMA representatives in Scotland and Northern Ireland will decide later this week whether they will press ahead with introducing the contract in their respective countries.

Dr Stephen Vallely, a member of the Northern Ireland consultants' committee said the split vote could be blamed on variations in trust between consultants and managers across the UK.

"The level of distrust between central government and consultants working at the coalface is vast."