Faecal incontinence.

control over the fees that patients pay.Fierce disagreement within the General Practitioners' Association over whether doctors should sign contracts with the new authorities resulted in the resignation of the association's chairman and executive and the election of a more conservatively inclined group.The government retreated on the issue and agreed to continue present arrangements for those who oppose contracts.Concerns in the public hospital sector centre on the commercialisation of the health service.The secrecy now surrounding management decisions has been heavily criticised as inappropriate for a publicly funded service.Fees for hospital care were introduced earlier than other changes and provided fuel for those concerned about possible privatisation.The strong negative public reaction led the government to abandon the inpatient fees, although charges for outpatient services remain.5The full potential of the restructuring will remain untested for the next few months.The problem for the government is that, with no additional money for extra services, any substantial change in the provision of services is also likely to be controversial.The disadvantages of change will get immediate (pre-election) publicity: any gains are likely to become apparent only in the long term (after the election).This may partly explain the current preoccupation with image-the appearance of change is important to justify the costs of the restructuring, but real change, which might upset powerful interest groups, will be avoided until after the election.We do not yet know whether the image will reflect reality.