NHS consultants have moved a step closer towards taking industrial action.
Consultants rejected a new contract last year
Doctors at a British Medical Association conference in London have overwhelmingly backed calls to ballot consultants on possible action.
It follows the government's continued refusal to re-open talks on a new contract, which was rejected by consultants last year.
In a statement, Dr John Reid, the new health secretary, said he had no intention of renegotiating what he described as a "generous deal".
The BMA vote could pave the way for consultants in England and Northern Ireland to take industrial action within months.
Any ballot on industrial action will not include consultants in Scotland and Wales because they are already in talks to introduce the contract.
Industrial action could include a work to rule where consultants would refuse to work overtime or fill out paperwork.
They could also decide against carrying out routine operations on patients, only providing cover for emergencies.
The BMA has been pressing the Department of Health to re-open talks on a new contract for over six months.
But in a statement, Dr Reid said: "I have looked carefully at the offer made to consultants in the contract that the BMA agreed last year with the health department and I see no reason to renegotiate that generous deal.
"It's a pity that some consultants have proposed this course of action even before I have had an opportunity to meet their representatives."
Consultants overwhelmingly rejected a proposed new contract last year.
They voted against substantial pay rises because of fears they would be forced to work evenings and weekends.
They were also concerned that the contract would give NHS managers too much say over how they work.
Consultants at the conference were urged to call "the government's bluff".
Dr Roger Ferguson, a consultant from Merseyside, said: "We have to negotiate - we have to talk to each other.
"If they refuse to talk we have to take industrial action."
Another consultant, Mr Andrew Hobart, from London, said: "We need a national contract for a National Health Service.
"If the only way to do that is to threaten industrial action then be prepared to do that."
Plea to ministers
Mr Nizam Mamode, deputy chairman of the BMA's consultant's committee, said: "We do not want to do this but we have been forced into this position.
"We have tried everything possible to get the government back to the negotiating table."
As health secretary, Alan Milburn consistently rejected calls from the BMA to reopen talks on the contract.
His successor Dr John Reid, who has been in the post for just six days, has so far made no comment on the issue.
Dr Paul Miller, chairman of the BMA's consultants committee, told the conference that swift progress on the issue was possible.
He said: "Even now, there is no reason why we cannot make progress with the new health secretary to achieve quickly a sensible outcome to our contract problem.
"A fair outcome giving both parties what they need, and which will be good for patients and the NHS.
"We have never left the discussion table, and it is time for the Department of Health to rejoin us."
The Liberal Democrats urged ministers to re-open talks with the BMA.
"The government has seriously and culpably misjudged the mood of hospital consultants," said Dr Evan Harris, its health spokesman.
"John Reid should announce the reopening of negotiations immediately to head off what would be an entirely unnecessary and damaging dispute."
The consultants conference has also debated the government's controversial proposals to create foundation trusts.
Doctors have warned that plans to free the top-rated hospitals from government control runs the risk of creating a two-tier health service.