GPs and hospital doctors have repeated and strengthened their opposition to key elements of the government's NHS plan.
At a special meeting last week, the British Medical Association's consultants' committee 'firmly rejected' the plan's proposals to ban consultants from private practice for seven years as 'irrelevant and insulting'.
And after another special meeting, the BMA's GP committee rejected the plan's commitment to a 48-hour target time for GP appointments as 'undeliverable' without an expansion in GP numbers.
Joint deputy chair Dr Hamish Meldrum said patients were being promised a 'Rolls Royce' in the plan 'but they won't have a driver'.
'It's like moving from the corner shop to Tesco, but the quality won't be like Tesco. That has to be made clear to patients, 'he said.
GP committee chair Dr John Chisholm also said doctors needed to emphasise that there was a 'trade off between consumerism and personal service'.
He said the plan was promising 'routine general practice on tap' but predicted it would not work unless demand management was tackled. He also said such a service could not be delivered with the 2,000 additional GPs promised over the next four years.
Joint deputy chair Dr Simon Fradd said GPs would need extra cash to meet the government's demands.
He said the development of higher quality services had 'huge implications for GP expenses' and called for staff costs under the traditional red book contract to be reimbursed at 100 per cent.
A 'robust defence' of single-handed practitioners is also in the pipeline.
The plan says they could be pushed on to a new, national personal medical services contract if quality standards cannot be agreed within the current funding arrangements.
Dr Fradd said the cost plus contract had 'served GPs very well' and should be made 'fit for purpose for the 21st century'. PMS contracts should be negotiated in parallel, he said.
But NHS Confederation policy manager for primary care Jane Austin said GPs needed to 'broaden the debate'.
The vision emerging from the NHS plan was about multidisciplinary teams, she said. 'Simply focusing on one of the groups in the primary care area and saying that the proposals are undeliverable is perhaps unhelpful.'
Dr Peter Hawker, chair of the BMA's consultants' committee, said the government had 'forgotten its own commitment to joined-up public policy' with its proposals to limit consultant private practice.
'It wants the private sector to work in harness with the NHS to reduce waiting lists. NHS trusts are themselves major providers of private care and yet it seeks to tie new consultants into an exclusive contract with the NHS, ' he said.
'Restricting what doctors do in their own free time is not going to result in more patients being treated in the NHS. It simply deprives patients of choice.'
The consultants' negotiators' meeting also turned down proposals for a new specialist grade of hospital doctor below the level of consultant.
But its stance on private work appears to conflict with the views of Barry Jackson, president of the Royal College of Surgeons, who told The Independent his personal view was that consultants should remain firmly in the NHS in the early stages of their careers.
NHS Confederation policy director for human resources Andrew Foster said there was a 'determination to tighten up' the management of consultants' time when they were working for the NHS.
He added: 'When the consultants get over the initial shock they will find the government is prepared to talk about how to implement this.'