Our current ratio of junior doctors to consultants limits the extent to which consultants can deal directly with patients. In order to achieve a consultant provided service, we require a substantial increase in the total number of consultants and a corresponding reduction in the number of non-consultant hospital doctors. Significant change will be needed in the current consultant contract. Consultants will be expected to work in teams, sharing responsibility for patients with their consultant colleagues. Agreement will be required to enable consultants to participate, as required, in the provision of on-site cover in the hospital over the 24 hour period and there must be clarity regarding the proportion of a consultant's time appropriately spent on clinical and training commitments. These requirements are essential to the development of a genuinely consultant provided service. There can be no question of moving to this system in the absence of a substantially changed contract.