Poor team work is killing patients.

News The health secretary, Alan Mil-burn, vowed last week to press ahead with reforms in the health service and to use money promised in the consultants' contract to buy more of doctors' time for the NHS. Speaking in front of the health select committee, Mr Milburn told ministers that the £250m ($400m; 390m) promised in the proposed contract for consultants and " liberated " by the doctors' rejection of the contract could now be used to " incentivise " doctors to do more work for the NHS. After expressing disappointment that the long negotiated contract had been rejected, Mr Milburn said that his department was considering a number of options to fulfil pledges laid out in the NHS Plan to deliver better services to patients. " Negotiations [with the medical profession] are impractical, but my door is open to the medical professions' leaders, " said Mr Milburn. " What we do have are substantial resources that we want to use to reward those consultants who do the most for the NHS. However, there can be no doubt that if we are putting more money in we want to see some changes. The medical profession will get itself into a difficult position if people are not prepared to be accountable and answerable. " Mr Milburn said he would welcome the introduction of the contract in Scotland and Northern Ireland, where the majority of doctors voted to accept the proposals. And he could see no reason why individual hospitals and trusts in England and Wales, where the contract had been rejected (BMJ 2002;325:1053), could not adopt the contract if a majority of doctors was in favour of it. The BMA is due to meet with Mr Milburn on Thursday 21 November to discuss how they progress from here. Edwin Borman, deputy chairman of the BMA's Central Consultants and Specialists Committee, said it was possible that Scotland and Northern Ireland would now pursue separate implementation of the contract in those countries. " England will resist any attempts at piecemeal implementation of the contract, " he said. " We have a very clear steer from our members, that the draft contract is unacceptable. Any attempt to implement it will be resisted. " Wales had a very clear vote against, but we are aware that the Welsh department of health may want to discuss matters further. I don't know how that is going to be …