The publication of the NHS Plan in August 2000 represents the first attempt by an administration of any persuasion to undertake a comprehensive review of the current state of play and propose reform. The plan has been pored over at length in the medical and lay press. The purpose of this editorial is to consider how the NHS Plan might influence day to day practice in our departments.

In publishing the plan, the government has provided a huge and unmissible target for cynics and sceptics alike. While some of this is justified and healthy, there is no doubt that the principles and developments within the plan represent a real opportunity for improvement. The plan covers all bases and, inevitably, lacks detail in how the changes are to be implemented. We must, therefore, seize any opportunity to influence the delivery of the plan. Of concern, however, is the paucity of specific comment concerning emergency care in general and the role of emergency departments in particular. This is surprising as the principal problem identified by consultation with NHS staff and the public was the need to reduce waiting times in our departments. It is equally disappointing that emergency care is not identified as one of the principal clinical priorities along with mental health, cancer care and heart disease. Although we are inevitably biased, emergency care is regarded by many health professionals and the public as being a fundamental component of the NHS that has consistently failed patients as a result of under-investment and under-staffing.

There is some solace to be found with important initiatives throughout the continuum of care that should have beneficial impact on our workload. For example, the recommendations that by 2004 patients will have guaranteed access to a primary care professional within 24 hours and a primary care doctor …