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Although day surgery (DS) has been performed for many years, it has only relatively recently become a popular and acceptable method of treating many common surgical conditions. With considerable pressure to maximise resource usage DS has been seized upon as a way of stretching scarce resources further. A review of the amount of DS undertaken within the West Midlands region revealed that the current workload showed considerable variation both between districts and between consultants. In an effort to gain clinical commitment to increasing generally the amount of DS undertaken, and obtaining more uniform coverage of DS across the region, a consensus conference was held. The two aims of the conference were to set targets as to the amount of DS considered feasible at a procedural level, and to seek clinicians' views as to the obstacles to developing the service. Targets for 43 procedures at one and/or five years were obtained by the use of a modified Delphi consensus. The groups showed a high level of consensus in the targets reached. A variety of obstacles were discussed. We have shown that it is possible to involve a large number of doctors in the decision-making/target-setting process by using a modified Delphi technique. It remains to be seen whether those targets are met in clinical practice. Surprisingly, obstacles to development were mainly concerned with management and personnel issues rather than capital investment.

Family Health Service Authorities (FHSAs), since 1st April 1991, have been both 'managed', by the Regional Health Authority, and 'managing', their contractor services. Both situations are relatively new to them, their Region and the contractors. We examine the opportunities and potential problems of this major strategic change. These relate to: (1) the establishment of effective coordination between providers of primary care services; (2) the establishment of minimum basic standards of care and administration for GPs (based on those set for training practices by the Regional Advisors in General Practice); (3) the development and validation of a data collection system from General Practice which could be used to establish a morbidity database from general practice as a means of health needs assessment as well as for performance review.