Doctors across the UK have begun voting on whether to take industrial action for the first time in more than three decades.

The ballot, in response to the government’s pension proposals, started on Monday and will remain open until 29 May.

Ballot papers will be sent to 103,000 members of the British Medical Association.

Ahead of the ballot the BMA has issued advice to its members, making clear patient safety must remain the priority during any industrial action.

It said members must not withdraw all labour and that doctors must continue providing emergency procedures, investigations and discharges of patients. Urgent surgery, discharge documents needed for safety reasons, emergency admissions and maternity attendances should continue to be covered as well.

Services likely to be affected in hospitals include diagnostics, elective and urgent treatment, clinical coding, non-urgent outpatient appointments, clinical audit, non-urgent discharge summaries and management meetings.

GPs have been told practices should be open for their usual hours but only urgent care appointments and no routine or pre-booked appointments should take place.

The ballot asks BMA members two questions: “Are you prepared to take part in industrial action short of a strike?” and “Are you prepared to take part in a strike?”

Dean Royles, director of NHS Employers, said: “We all know even action short of strike, such as a ‘work to rule’, will have an impact on patient care.

“An actual strike by doctors would mean delays to planned operations and other non-emergency care, and would be particularly distressing for patients and extremely worrying for staff, dedicated to putting patients first.”

BMA consultants committee chair Mark Porter said: “In developing our plans for industrial action, we’ve been very clear about two key principles. Patient safety is our absolute priority, and advance planning with managers is essential.”