Managers should ensure that doctors know what is expected of them

The working practice of hospital doctors is not immune from the rapid changes occurring in the NHS. Already initiatives are eroding the traditional model of the consultant led medical firm. The combined effect of Achieving a Balance,1 the new deal on junior doctors' hours,2 and the Calman report3 has been to reduce the amount of support that consultants receive from junior doctors. The logical conclusion must be that we are moving away from a consultant led service towards a specialist based service. Such a change will have substantial implications for the working practices of hospital doctors and will need to be managed carefully and sensitively. Already some NHS trusts are bringing about some changes in this direction through their contracts with new consultants.

The Doctors' Tale, the recent report from the …