The British Medical Association in Scotland has said politicians will need to rise above “mere accountancy” and “tribal politics” to think seriously about the long-term survival of the NHS.

Chairman Dr Brian Keighley made the comments as he addressed the BMA’s annual conference in Cardiff.

The SNP promised to protect the health service from cuts as part of its election manifesto commitments.

Dr Keighley said: “First and foremost this government must admit that even with the protection of the health budget, promised during the recent election, the NHS faces tough times and that means tough choices.

“It is against this background that the SNP remains committed to its high-spend agenda - free personal care, free education and a range of other universal policies.

“But to pay for these policies, we are told that the public-sector workforce must make sacrifices and accept a continuing pay freeze - the so-called “social wage”.”

Dr Keighley also warned against changes to doctors’ terms and conditions.

He said: “More covertly perhaps, the government seems to be embarking upon an attempt to undermine and attack doctors’ terms and conditions of service as a means to save money. And while we recognise that savings need to be made, this is not acceptable.”

Dr Keighley called for a “sensible and public debate” to look at what the NHS can and cannot afford to deliver.

He said: “Managers and politicians will need to rise above mere accountancy and tribal politics to think seriously about the long term survival of the NHS.

“In order to do this successfully, doctors and other health professionals will have to be at the heart of the debate.”

Responding to Dr Keighley’s speech, a Scottish government spokesman said: “We agree doctors and other health care professionals should be at the heart of discussions about the future of the health service in Scotland.

“We are committed to ensuring all doctors are fairly and equitably rewarded for their contribution to delivering high-quality patient care for the people of Scotland.”

Murdo Fraser, Conservative health spokesman, said reducing management costs and re-directing funds to frontline services was necessary.

He said: “These are tough times and the SNP now has no excuses for failing to deliver. We need more honesty from them if we are to give our NHS all the support it deserves.”