Family doctors in England will vote on whether to introduce a subscription-based charging system for patients, the British Medical Association has announced.
The BMA's GP committee confirmed it would ballot members on establishing a "means-tested, subscription-based service" as an "alternative model" to current NHS arrangements.
The scheme could mirror existing NHS dental services, where patients face charges reaching £319 for certain treatments.
Dr Katie Bramall, who chairs the BMA's GP committee, attributed the move to years of political neglect.
Family doctors are battling a mounting workload
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"This exploration of an alternative model is a consequence of long-term political and systemic failure to protect NHS general practice and has left the profession deeply frustrated, with no other choice but to explore alternatives," she told Pulse magazine.
The union's GP committee chair said family doctors are battling mounting workloads while simultaneously managing patients with increasingly complicated health requirements.
Delivering safe care has become progressively more difficult under these circumstances, Dr Bramall explained.
"Under current contractual arrangements, GPs are prevented from meeting patient demand for some services. These obstacles limit our ability to deliver the care patients ask for or deserve, restricting clinical flexibility," she told the publication.
Confidence in general practice's future within the NHS has plummeted to unprecedented depths, according to Dr Bramall.
The committee described the proposed model as a potential "plan B" offering practitioners increased autonomy to deliver private services.
Earlier this month, representatives at the UK Local Medical Committees conference backed developing a strategy for potential work beyond NHS structures.
The Department of Health issued a stark warning against the proposed changes.
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"Moving towards a model of private, means-tested or subscription-based GP services is not in the interests of patients or the NHS," a spokesman said.
"A two-tier health system would only serve to deepen the health inequalities that already exist."
The department says it remains committed to preserving the NHS's core principle that treatment remains free when patients need it.
"The founding principle of the health service that care is free at the point of use must be protected, and we will do so. We want to work with GPs to build a sustainable future for primary care as the front door of the NHS," the spokesman added.
Dr Bramall indicated the ballot could be abandoned if ministers agreed to address concerns about GP contracts, wellbeing and livelihoods urgently.
Resident doctors, previously known as junior doctors, have announced industrial action next month following the collapse of pay negotiations.
The walkout will span four days, commencing at 7am on June 15.
BMA representatives turned down an offer that would have pushed some doctors' earnings into six figures.
Confidence in general practice's future within the NHS has plummeted
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The union cautioned that additional strikes could follow in July should discussions fail to yield results.
This latest action comes amid broader tensions between medical professionals and the government.
In 2024, the BMA encouraged GPs to undertake widespread disruption over an imposed contract, with doctors permitted to select from various protest measures, including limiting daily appointment numbers.
GP partners currently operate as self-employed practitioners, with average pre-tax earnings of £159,000 during 2023-24.
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