Intended for healthcare professionals

Education And Debate

Professional self respect: rights and responsibilities in the new NHS

BMJ 1998; 317 doi: (Published 24 October 1998) Cite this as: BMJ 1998;317:1146
  1. Peter Richards, president (
  1. Hughes Hall, Cambridge CB1 2EW
  • Accepted 5 October 1998

The NHS faces a widening gap between demands and resources. 1 2 The UK government has promised substantial additional funding over the next three years. In return, it expects doctors to help reshape the delivery of health care. Meanwhile, as a result of the Bristol case 3 4 (in which two surgeons from Bristol were found guilty by the General Medical Council of continuing to operate on children when they knew their death rates were unacceptably high) the public is asking whether doctors can be trusted,5 and government ministers are murmuring that the medical profession is a law unto itself. Certainly, the public and politicians suspect that doctors cover up their failings, although neither perhaps would go as far as George Bernard Shaw in asserting that “every doctor will allow a colleague to decimate the whole countryside sooner than vitiate the bond of professional etiquette by giving him away.”6

Summary points

  • The UK government has promised additional funding for the NHS in the expectation that doctors will help reshape the delivery of health care

  • The General Medical Council is exploring ways to ensure that doctors are meeting agreed standards of knowledge and practice

  • There is an insufficient contractual framework for ensuring that consultants are accountable for delivering high quality service

  • The current contract for consultants is neither an accurate reflection of the reality of their work nor is it an effective means of identifying their commitment to the NHS

  • It is time for a flexible contract that identifies the work to be done and recognises those who do it and rewards them accordingly

  • The government has a duty to ensure that the personal cost to doctors and others of being both accountable and professional is not so high as to undermine the future of the NHS

Accountable professional self regulation

If the process of …

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