The British Medical Association has vowed to campaign against increased competition and privatisation as the NHS feels the effects of the recession.

Chairman Hamish Meldrum said the NHS faced rising demand, pressure for greater efficiency and, in future, less funding. He said: "The NHS needs stability at this time… not competition for the sake of competition, with the consequence of fragmentation.

"We are focusing on competition and the market which does seem to [mean] provider and provider or commissioner and provider against each other." He said the BMA would "keep a close eye" on responses to tighter finance. He said doctors should "be involved at all levels" and decisions should be made "for the right reasons rather than financial expediency".

Responding to concerns about applying the European working time directive to junior doctors, Dr Meldrum said an exemption was not possible or desirable. The BMA this week also issued a report saying many doctors still have problems with choose and book.