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Professionalism and advocacy.

The stated aim of these contract negotiations has been to ensure that consultants are more answerable to the health service, working either entirely in private practice, or entirely in state service, and directly answerable to their ‘manager’, rather than their patient. Much emphasis has been there on increasing the duration of the working week from the current contract of 33–39 hours per week, with a contracted obligation for consultants to be working in the hospital on a 24 hours per day basis, particularly in anaesthesia, paediatrics, obstetrics and emergency medicine. Many of the areas of initial difficulty have been agreed in principle, if not in specific detail. One area is, however, of continuing contention, which has had a marked bearing on delayed agreement of the contractual change. That area is the one of advocacy on behalf of patients.