Overuse injuries in musicians.

the problems that plainly exist in the NHS. Introducing medical audit, developing better information systems, devolving budgets to doctors whose decisions commit the expenditure of public money, revising the element of cross boundary flows in the RAWP (Resource Allocation Working Party) formula, searching for ways of rewarding rather than penalising productive hospitals, and controlling excessive prescribing are all activities that have been debated for some time, and most have been issues in which doctors have been prominent in pushing for change. The white paper's proposals in these matters may not be sufficiently detailed or wholly practicable, but there should be debate about their merits as instruments of change. Thus it would be wrong to reject parts of the white paper that are merely building on trends already underway without making alternative suggestions for tackling the important problems they deal with, although the service has not been encouraged to respond critically and selectively to different proposals. But the government should also recognise why its white paper has aroused such antagonism and seek to answer its critics with detailed evidence and argument rather than bland reassurance. The central notion of the internal market might be made to work for the benefit of patients in certain circumstances, but the evidence-for example, from a series of demonstration projects-needs to be assembled before its national introduction. It is with the aim of raising the debate that the BMJ has published the series of articles that concludes today. (The series is to be published as a book that will be available by 8 May.) Perhaps the time has come for the posturing to stop and the detailed discussions to start. Otherwise the NHS and those whom it serves may become victims of the verbal cross fire.