Time for change in traditional working practices?

Consultants in Britain are under pressure to change the way they organise their work. Many rely on formal, but unwritten, rules and a culture of "learning by doing." Unlike their counterparts in Sweden, they are often not well integrated into the management systems of their hospitals. The result is wide differences in the NHS workloads of individual consultants and, for a minority, conflicts of interest with their private work. The training received by junior doctors varies because it is largely left to individual consultants. Clinical directorates should provide a more effective mechanism for consultants to influence trust policies and for consultants to implement these policies. Consultants must not only recognise the need for change but also seize the initiative.