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It’s hard to argue against the sentiments of continuity of care, longer consultations, and empathy in general practice put forward by Gray and colleagues,1 but it’s also hard to reconcile this wish list with the trend for flexible working, early retirement, …

Doctors at the BMA’s annual representative meeting have expressed strong doubts about NHS England’s strategy for the next decade, published in January.1 Representatives voted overwhelmingly against a part of a motion proposed by the Wigan division that the meeting, being held in Belfast this week, “welcomes and supports the aims and initiatives of the plan.” Tom Dolphin, a consultant anaesthetist and member of the BMA Council, proposing the motion, compared the NHS Long Term Plan to a “sketchy unfunded wish list for the NHS.” He said, “The plan has two major problems: …

We report a unique, collaborative effort by users and providers of genetic services to arrive at outlines for optimal ethics and clinical practice. Using focus groups of consumers (users) and providers (held separately), a provider-consumer project team developed 1) a consumer wish list, 2) an experientially based ethical overview of situations arising in practice, and 3) detailed suggestions for consumer-provider interactions in clinical settings. Consumers were primarily interested in accurate information, respect for persons, a smoothly functioning team, with the consumer as an equal member of the team, family integrity, and providers who knew the limits of their knowledge and were willing to refer. “Non-directive” counselling and privacy were not major issues in consumer focus groups; some thought providers should openly state their own opinions. Providers had a rather different list of priorities. Books and papers on clinical ethics usually originate from bioethicists and physicians. This pilot project is unique in including consumers and providers equally.

The junior doctor contract is out of date, but how could potential negotiations improve it? Helen Jaques asks some of the trainees at this year’s BMA Annual Representatives Meeting

At the top of Douglas Gwatidzo’s wish list for Zimbabwe is a return of all those health professionals who have left the country in the past decade. Dr Gwatidzo is chairman of the Zimbabwe Association of Doctors for Human Rights. His colleague, Rutendo Bonde, hopes for accountability in the health service, professional engagement, and governance backed by a legal system with teeth. This might feel like pie in the sky for some, but conditions in Zimbabwe have changed in the past 12 months, and there is a real sense of optimism. “We are living on hope,” Dr Gwatidzo told the BMJ . The Zimbabwe Association of Doctors for Human Rights, which Dr Gwatidzo helped to establish in 2002, was originally set up to monitor the use of organised violence and torture in the country but has since broadened its remit. In the past five years it has also played a part in ensuring that the medical curriculum includes human rights and related matters and promotes activities in the areas of health of prisoners, child and maternal health, and HIV/AIDS. Dr Bonde, originally an anaesthetist, runs …

Editor—Rayner's wish list in her personal view about a patient's eye view of quality in the NHS contains nothing that I would not want for myself as a patient, but her article fails to address issues of resourcing, except where she mentions the “sizeable fees collected” by alternative practitioners.1 In a crowded surgery recently I spent half an hour with an anxious patient exploring the patient's concerns about forthcoming hospital treatment. I met that patient's needs and wants, and as a result my surgery ran late and other patients in the waiting room grumbled. This sort of thing happens all the time and cannot be solved by bringing the patient back at a quiet time because there aren't any such times. In any case, that would hardly satisfy Rayner, who wants us to be responsive to our patients' anxieties at the time when they are expressed. We cannot please everyone all the time or guarantee always to satisfy such a comprehensive wish list within existing time pressures and limited resources. British general practitioners know how to provide a quality service, and usually do, but are compelled to provide a high volume economy service in which there is no limit on demand. To make it through the day we sometimes have to compromise on the niceties of life, unlike the alternative practitioners, in whose case the money comes with the patient. I recently paid around £1000 to fly economy class to New Zealand. It was OK but cramped, and I didn't like the films. A first class ticket would have been much more agreeable, and, like Rayner's vision of the NHS, would have cost about twice as much. If the Patients Association wishes to make a useful contribution to the debate on quality I suggest that it gets together with the GP Committee and starts a postcard campaign, getting patients to write to their MPs. These patients should say that they are willing to pay their share of whatever it takes to get health spending in the United Kingdom up to the European (or better still, the Franco-German) average.

The problems of planning the medical workforce are chronic and recurring. The national overview of supply and demand for doctors in both primary and secondary care has consistently been found to be inaccurate. This has led to many problems, such as wild swings in the planning of opportunities for specialist registrars. Some specialties have seen substantial increases in training placements demanded one year followed by equally large decreases the next year. Against this background, one has to consider whether the ideal of effective workforce planning is a realistic proposition. There is a clear need for national coordination in data collection, yet there seems to be a reluctance to provide it. Planned consultant expansion, as recent experience in obstetrics and gynaecology has shown, cannot be achieved in the absence of policy and funding to support it. Planning merely on the basis of a “wish list” is ineffective. Planning the make up of tomorrow's medical workforce is a complex business. The challenge is to decide the optimum mix of skills that should be in place and then monitor continuously to ensure that this mix remains sustainable in a constantly changing healthcare environment. This can be achieved only through effective management of information, with a computer database being used to provide the necessary “snapshot” overviews for planning purposes. Yet the criteria for a suitable system are exacting because of the complexity of the many different variables involved. These variables encompass both the numbers of doctors in training (the supply) and the numbers of qualified doctors in service (the demand). It is important to remember that trainees provide a great deal of the service no matter how often they move around for educational purposes. Other key factors for consideration include the number of known and projected consultant vacancies and how many posts are filled …