By Ray Dunne
BBC News Online health staff
"Doctors to seek all out pickets", "Doctors consider strike escalation" and "Minister is urged to intervene in dispute".
Consultants could take industrial action later this year
These headlines are just a sample of those that have dominated newspapers in recent weeks.
They are, of course, not headlines from British newspapers. They come from The Irish Times and refer to an on-going dispute involving public health doctors in Ireland.
However, newspapers in Britain could be printing similar headlines within weeks.
NHS consultants are edging ever closer to taking industrial action.
They are becoming increasingly angry and potentially militant over the government's refusal to re-open talks on a new NHS contract.
A conference on Wednesday is expected to give the go-ahead to a nationwide vote asking doctors if they are prepared to take industrial action.
Dr John Reid's recent appointment as health secretary could help to diffuse the row if it leads to fresh discussions with the BMA.
But either way, consultants appear determined to have their case heard.
There are indications that a majority are now prepared to take industrial action.
This is unlikely to take the form of consultants waving placards outside NHS hospitals.
But it could lead to consultants refusing to attend managerial meetings or complete paperwork.
It could also see consultants providing only emergency cover and refusing to carry out surgery on elective patients.
"The impact could be quite significant," says Dr Paul Miller, chairman of the BMA's consultants committee.
"Waiting lists would rise very significantly and very quickly."
The threat by consultants to take industrial action is unprecedented in the history of the NHS.
"It has never reached this stage before," says Dr Miller.
Reluctant to strike
But there is growing evidence that consultants are prepared to make good on their threats.
In the past, they, like GPs and junior doctors, have proved very reluctant to take industrial action.
They often get their way. Threats have usually been enough
Professor Roger Seifert,
With just one or two exceptions, previous threats have disappeared into the ether with either the BMA or government capitulating at the eleventh hour.
"Previous governments have been reluctant to take on the BMA," says Professor Roger Seifert, director of the Centre for Industrial Relations at the University of Keele.
"The BMA also knows that any serious dispute would divide the profession and would quickly lose it public support," he says.
"They often get their way. Threats have usually been enough."
The last time the BMA took industrial action was in the 1970s when junior doctors were in dispute briefly over their pay and conditions.
At the same time, consultants were engaged in a work to rule over government plans to phase out so-called pay beds - beds in NHS hospitals which were available to private patients at a price.
Since then, the BMA and successive governments have avoided the need to take official action.
In 1985, GPs threatened to take industrial action over the government's refusal to increase funding for out-of-hours care.
That threat was enough for ministers to cough up more money.
In 2001, GPs threatened in the middle of a general election campaign to resign from the NHS unless the government opened talks on a new contract. Their wish was granted within weeks of Labour returning to power.
"They are a powerful lobby," says Professor Seifert. "The BMA is a good old fashioned trade union. They are tough minded in pursuit of their own economic interests."
In recent years, the BMA has not had to deliver on its threats. But there are many who believe it is incapable of doing so since most doctors are generally unwilling to go on strike.
Few have a personal history of strikes having grown up far from the picket lines of Britain's coalmines and steelworks.
In addition, most acknowledge that industrial action in any form can adversely impact on patients, something many are unwilling to contemplate.
"Doctors are not unique but we have a higher degree of recognition of our responsibilities," says Sir Alexander Macara, a former BMA chairman.
"We do, after all, deal with matters that are literally life and death.
"The hope is that a threat to take industrial action is enough to persuade the government to acknowledge the problem," he says.
"When it comes to the point where there is a really nasty difference of opinion, both sides tend to take stock and pull back."
Consultants are waiting for new health secretary Dr John Reid to do exactly that.