Senior hospital doctors have rejected proposals to change the way they work, in a move that threatens government plans to modernise the NHS.

Doctors voted by almost two to one against a proposed new contract in a UK-wide ballot.

However, while the deal was rejected by doctors in England and Wales it was accepted in Scotland and Northern Ireland.

I always said it was the only contract on offer. There can be no re-negotiation

Health Secretary Alan Milburn

Health Secretary Alan Milburn insisted there would be no renegotiation of the package suggesting the contract could be introduced in some parts of the UK and by some trusts regardless of the result.

The contract, drawn up after years of negotiations between the BMA and Department of Health, was originally presented as a "win win" deal for consultants.

However, many doctors criticised the contract saying it gave NHS managers too much power and threatened their independence.

Split vote

Overall, 62.5% of doctors voted against the deal on a 74% turnout. Opposition was strongest in England and Wales where 66% voted against.

Dr Hawker has resigned following the result

It was narrowly accepted by doctors in Scotland, where 59% voted in favour, and in Northern Ireland, where 54% backed the deal.

Dr Peter Hawker, chairman of the BMA's consultants' committee and head of its negotiating team, resigned following the result after four years in the job.

"Consultants have delivered their verdict. It varies across the UK but of course I accept and respect it," he said.

Members of the BMA's consultants' committee are now meeting in special session to discuss the ballot result and their next step.

There had been calls for the BMA to re-open talks on the contract with the Department of Health if the vote was rejected.

Next step

However, ministers have indicated that this is a non-starter. There is speculation the contract will be offered in Scotland and Northern Ireland where a majority of doctors backed the deal.

We will need urgent discussions with the health secretary to clarify the government's position

Dr Ian Bogle, BMA

Hospitals could also offer the contracts to newly-appointed consultants and to existing doctors who voted in favour.

Mr Milburn said: "In some hospitals, management and consultants may come to an agreement and decide they want the contract operating in their hospitals."

The BMA called for an urgent meeting with Mr Milburn to discuss the result.

Its chairman Dr Ian Bogle said: "Clearly, we will need urgent discussions with the health secretary to clarify the government's position."

But Mr Milburn indicated the government was not prepared to move.

"It took two years of tough negotiation to get to this point," he said.

"I always said it was the only contract on offer. There can be no re-negotiation. There can be no more resources. There can be no veto on reform."

He added: "This was always going to be difficult. Reform through whatever means now has to go ahead."

Pay rise

Under the proposed deal, consultants would have received pay increases ranging from 9% to 24%, depending on their age and experience.

In return, they would work 40 hours per week for the NHS and could be asked to work evenings and weekends.

Ministers said flexible working arrangements were essential if trusts were to cut waiting times.

Under the contract, consultants would also have been expected to work additional hours in the NHS before working in the private sector.

The BMA said negotiations on a new contract for GPs remained on track despite the consultants' vote.