Intended for healthcare professionals


Doctors in chambers

BMJ 2003; 326 doi: (Published 22 March 2003) Cite this as: BMJ 2003;326:611

Perhaps the time has come for a new way of doing business with consultants

  1. Pam Garside, health services consultant (,
  2. Andy Black, health services consultant (
  1. Judge Institute of Management, University of Cambridge, Cambridge CB2 1AG
  2. Durrow, PO Box 22, Macynlletch SY20 8WQ

    Hospital doctors in England have overwhelmingly rejected the offer of a new consultant contract from the government.1 It seems that they object to being controlled by managers. On deeper reflection this vote probably represents a wider rejection of an outdated form of contracting for medical services. It could also mean that the BMA, who negotiated on behalf of the doctors, is out of touch. A new contract is also under consideration for general practitioners. The context for the delivery of medical care is changing—is now the time to develop a new model of “purchasing” the medical resource, in the United Kingdom and other countries? Will doctors move to a chambers style arrangement, traditionally used by the legal profession?

    The word chambers is now commonly used in current discussions as a generic word to refer to alternative organisational forms for doctors to sell their services to the NHS and to other payers—very few have been established. The two main groups of UK doctors, hospital doctors and family doctors, have traditionally been remunerated in completely different ways. Hospital doctors are salaried employees of NHS organisations whereas general practitioners operate …

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