The time has come to replace NHS consultants' erratic yearly job reviews with formal appraisals, argues a leader in the Postgraduate Medical Journal(1999;75:325). An appraisal system might be expensive to set up and difficult to organise, but at least it would signal that the NHS is serious about clinical governance and values quality over quantity from its consultants. Review should be external, says the leader, and based on a robust set of performance data that can be compared nationally.

Nurse practitioners who give drugs, take blood, and put in intravenous cannulas can also field calls for surgical house staff during the night. In an audit of calls from eight surgical wards in one Scottish hospital a nurse practitioner dealt with nearly half of the overnight calls, leaving the junior doctor to sleep longer and presumably deal better with the working day ahead (Scottish Medical Journal1999;44:52-3). The top 10 reasons for calling out a junior doctor in the middle of the night included essentials like pain relief and fluid management as well as less urgent matters such as writing a death certificate.

The United Kingdom's transplant authority, which matches and allocates donor organs, has written to all chief executives of NHS trusts urging them to make …