By Nick Triggle
BBC News at the BMA conference, Belfast
Doctors leaders have been condemned for failing effectively to oppose government attempts to make the NHS more market-driven.
Doctors fear reforms are counter-productive
The British Medical Association's annual conference backed a motion accusing the leadership of letting down patients, the profession and country.
Doctors decided not to affiliate the BMA with anti-private sector campaigners Keep Our NHS Public.
But they did attack private sector involvement in a series of debates.
In recent years ministers have made the NHS more like a market by giving patients choice over where they are treated, introducing new providers from the private sector and paying hospitals per patient treated.
Many doctors are unhappy with the policies, believing they are destabilising the NHS.
'Too close to government'
Birmingham GP Fay Wilson said the health service was being sold off and doctors were disappointed that the BMA had not been more robust in its efforts to oppose reforms.
She told the Belfast conference the BMA should be more proactive - just as they had been when they campaigned against a smoking ban.
She said: "We need action as well as words."
BMA members are thought to believe council chairman Mr James Johnson and his senior team are too close to government.
But Mr Johnson defended his approach saying "if we went along [to meetings with ministers] and just said we don't like your policies, we would not be invited back".
"Then we would have no influence."
However, Mr Johnson did succeed in convincing representatives not to affiliate the BMA to Keep Our NHS Public.
The coalition of MPs, doctors, trade unions and patients was set up last year to oppose the involvement of the private sector in the NHS.
The group is also against PFI hospitals and private clinics providing minor NHS treatment such as cataract surgery - all of which are key parts of the government's plans to create a more patient-centre, market-based NHS.
Mr Johnson said he was happy to support the principles of the campaign group.
But he said it would be risky to "sign up to other people's campaigns" as they could be supporting something the BMA did not agree with in the future.
Earlier, in his address to the conference, Mr Johnson said government plans to encourage private firms to bid to run GP services were a licence for them to "print money".
"You hear politicians say there's no difference between GPs, who are independent contractors commissioning services, and private organisations also doing so.
"There is one huge difference - GPs are steeped in the ethos of the NHS and answerable to their patients."
And to cheers from the audience, he added: "Private organisations are answerable to their shareholders."
Other government reforms were also attacked by representatives at the conference.
Dr Geoffrey Lewis, from Leicestershire, said hospitals could be heading for destruction as the government was aiming to move care out into the community depriving hospitals of money while they still had huge overheads.
Mr James Johnson delivers his address
And junior doctor Jennie Blackwell likened offering patients choice of hospitals to double-speak in George Orwell's novel 1984.
"Patients want a choice of a good local hospital. We should be concentrating on quality."
London GP Dr Chaand Nagpaul said the deficits crisis - the NHS finished last year over £500m in debt - was "lamentable".
"This once in a lifetime investment opportunity is being squandered in front of our eyes, leaving the NHS paralysed with cuts in services and staff and unable to afford cancer treatments available in other nations."
He said the problem was not caused by "profligate spending by NHS trusts" and increased doctor pay, but perpetual reorganisation and overspending on IT, management consultants and the private sector.
Shadow Health Secretary Andrew Lansley said ministers had imposed "endless" reforms on NHS professionals without providing an incentive to improve outcomes or consulting them adequately.
He said: "Public services can be improved if public servants are trusted more. It is essential that we fully engage health professionals."
He also called for GPs to be allowed to manage their own budgets, and to be able to reinvest efficiency gains in their own practices.
Health Minister Lord Warner said the government and devolved more power than ever before to frontline staff.
"We know that change isn't easy, but that doesn't mean we should be afraid of it, or shouldn't do it.
"Patients want more responsive services and the reforms are designed to achieve that."