Day case surgery and workload.

Mandate for NHS reforms SIR,-Where now for the BMA's policies on the NHS reforms?Concern that a market in health care would result not so much in managerial efficiency and a sensitivity to local needs but in winners and losers with widening gaps in the provision of health care led me to vote Labour.'2Although the general election was not a referendum on the reforms, the high profile of health as a pre-election campaign issue was as near as we are likely to get to one.The return of a Conservative government with a clear working majority means that a public mandate for the NHS reforms has been obtained, and I believe that the BMA should now put its full weight behind them.The purchaser-provider split will become a model not only for the NHS but for a wide range of centrally funded public services.Success in the United Kingdom will ensure that this model is exported to other countries, particularly in the expanding Europe.Recommending an enthusiastic and cooperative approach to the new political situation does not mean that we must cast aside our faculty for criticism.But criticisms must be more sharply focused.If individual patients are disadvantaged the reasons for that disadvantage must be examined rather than assumed and the finger pointed ac- curately at those responsible, be they the provider or the purchasing authority.Cooperation with management must not mean that the political pressure for better funding for the NHS should be abandoned.The exclusion of practising doctors from the management structure must regularly be