Twelve and half thousand senior hospital doctors may take strike action after walking away from negotiations over their contract, complaining the government is taking too long to sign it off.
Doctors on the staff and associate specialist contract - senior hospital doctors who are not in training or consultants but who are on national terms and conditions - will be asked by the British Medical Association to consider striking, working to rule or staging protests.
The BMA has accused the Treasury of delaying the contract and negotiators have formally withdrawn from further talks with NHS Employers.
Chair of the BMA's negotiating committee Dr Ashok Pathak said: 'There is one arm of the government in disagreement with the other. The Department of Health is ready to release the contact but the Treasury is holding on to it.'
The contract - agreed with NHS Employers and the Department of Health in November 2006 - has been with the cross-governmental public sector pay committee since February.
NHS Employers head of pay and negotiations Gill Bellord said she was disappointed the contract had not yet been approved to go to a BMA ballot.
'We remain confident that this is a good package for doctors and for patient care,' she said.
An NHS Employers spokeswoman said it was understood that the delay was happening because the Treasury wants to make sure the contract is affordable for employers.
A Treasury spokesperson said: 'Pay awards need to be closely scrutinised to ensure they are in line with the Chancellor's guidance on public sector pay. The public sector pay committee is currently considering the new contracts and will respond in due course.'
A DoH spokesperson said: 'We understand the frustrations at the time it has taken the government to make a decision about the proposed new contract. The government has been assessing the proposals, taking full account of value for money and the benefits to be achieved from the contract.
'It is only by doing this that a firm judgement can be made as to whether the proposed contract improves arrangements for these doctors, the wider NHS and patient care. A decision is expected soon.'
Staff and associate specialist doctors are the last group of NHS employees to have their contract renewed.