In the first article, based on workshops with doctors in the US and UK, Nigel Edwards and colleagues argue that workload and pay, though important, do not fully explain the problem. A key factor seems to be a change in the psychological compact between the profession, employers, patients, and society so that the job is now different from what doctors expected.
A new compact is needed, spelling out the rights and responsibilities of the government, the medical profession, and the public, say the authors. Clinical leaders have a crucial role in developing a new compact that improves care for patients, improves the effectiveness of the healthcare organisation, and helps create a happier workforce, they conclude.
The old implicit compact between the government, the medical profession, and the public has been undermined over the years and needs to be updated, say Chris Ham and George Alberti in the second article.
This will not be easy to agree but is essential to enable the different partners to make an effective contribution to the reform of the NHS. It is time to stop grieving for the past and to meet the challenges of the new world and the future, they conclude.