Doctors' leaders are accusing the government of reneging on a promise to use a predicted £1.8bn NHS surplus on patients and instead planning to carry it forward to next year.
The British Medical Association (BMA) has pointed out that the Department of Health's new NHS Operating Framework for 2008/09 says surpluses delivered in 2007/08 by strategic health authorities and PCTs should be carried to the next financial year.
"Each SHA area should then plan for a surplus in 2008/09 at least equivalent to that total," says the recent publication The NHS in England: The Operating Framework for 2008-09.
The BMA says: "The instruction comes just weeks after Health Secretary Alan Johnson pledged the excess money would be spent on tackling healthcare-associated infections and delivering faster treatment for patients."
BMA central consultants and specialists committee joint deputy chair Mark Porter said NHS staff had been assured the "pain" of achieving surpluses would result in greater service investment.
Mr Porter said: "Now the Operating Framework has been published, we discover the government is not delivering on that promise."