Keir Starmer will be unable to reform the NHS without tackling the doctor’s union, experts say.

NHS specialists say the government pledge to overhaul the health system will not be possible unless it can tackle the power of the powerful union, the British Medical Association, which has staunchly opposed key health reforms including the establishment of the health service itself in 1948.

The comments follow the landmark report into the NHS last week which described the health service as “in serious trouble.” The Lord Darzi review argues the NHS is facing rising demand as people live longer in ill health, coupled with low productivity in hospitals and poor staff morale. It set out themes for the government to incorporate into a 10-year plan for reform.

Speaking at an event in London on Thursday, the prime minister, Sir Keir Starmer, vowed to act on its findings: “We know working people can’t afford to pay more, so it’s reform or die.” But commentators warned that the BMA union will attempt to block any NHS reforms unless they serve the financial interests of doctors.

They cite the BMA’s 2016 strike action which successfully stopped government plans to make it easier and cheaper for hospitals to roster doctors on weekends and evenings.

The Government argued it would improve hospital flow as well as care at weekends and in the evenings, but doctors argued weekend work would affect patient safety by encouraging unsafe shift patterns. The BMA also blocked government attempts to extend GP surgery hours.

Stan Silverman, former deputy medical director of the NHS’s ­regulator, NHS Improvement, said: “We have seven day working among most of the rest of society, hotels, supermarkets, and taxi drivers do it. But the only way the BMA would agree to extended hours primary care was by paying them more. This means people get sicker and sicker at home over the weekend and then the GP system gets clogged up on Monday morning. In hospitals it has been harder to discharge patients because the hospital is not fully functioning at weekends which means patients who are medically fit to leave cannot always be discharged.

“The BMA is there to protect doctors. It has a vested interest in the status quo and saying what its members want it to say. It does not advocate for patients and in my experience this is very unhelpful in trying to get NHS reforms.”

Dr Silverman’s comments came as leading scientist, Professor Sir John Bell, said doctors in the BMA have been “a major drag on reform of healthcare.”

Professor Bell, who served as regius professor of medicine at the University of Oxford for more than two decades said: “If you’re thinking about eggs you’re going to have to break – I’m afraid that the stranglehold that the medical profession is broadly to have on the way we run a healthcare system is going to have to be sorted.

“I think the medical profession is locked into a way of life and a way of practicing medicine, but they are deeply conservative, and it’s very hard to move to a different place.”

Last week Health Secretary Wes Streeting said the BMA should stop “saber rattling” and work with the Government on the future of General Practice. Mr Streeting said there was still the “unnecessary threat of collective action” from the BMA’s GP committee that would “harm patients.”

Professor Phil Banfield, chairman of the BMA council, said the trade union had “long been at the forefront of calling for reform in the health service in England and the devolved nations.”

He added: “We are having positive conversations with the Health Secretary as both he and the BMA believe it is crucial that we rebuild the NHS and make it fit for the future. Now we have a Health Secretary that is prepared to listen, and it’s vital he does, working with us to undo years of untold damage.”