Does the completion of the closure of the old ‘mental deficiency’ hospitals in Great Britain mean that the relevance of learning disability as a major sub-speciality of psychiatry has been lost? In the past 10 or 20 years many non-psychiatrists, including service users, have blamed learning disability specialist psychiatrists for these hospitals and for many of the adverse social effects of being labelled as having a learning difficulty. With the new White Paper, Valuing People (Department of Health, 2001), is the role of the Faculty changing?

NHS Direct is a nurse-led telephone helpline covering England and Wales. The intention to develop this helpline was announced in December 1997 in a White Paper, The New NHS, Modern and Dependable (Department of Health, 1997), following recommendations in the Chief Medical Officers' report, Developing Emergency Services in the Community (Caiman, 1997). Three initial pilot sites were set up in Lancashire, Milton Keynes and Northumbria and began taking calls in March 1998. The project was extended in April 1999 to cover 40% of the population of England and by November 2000 was available throughout the whole of England and Wales. NHS Direct provides 24-hour advice and information via 22 call centres and is the largest telephone health care service in the world. A similar system is planned in Scotland, NHS 24.

When I was appointed to my consultant post nearly 10 years ago I was one of several able candidates. This was the culmination of many years' hard work and I was proud to be working at an inner-city teaching hospital, one where I had trained as a medical student. This was probably the last time that my department was fully staffed, with each year since bringing more challenges. In recent years only one of the specialist registrars I have trained has continued with general psychiatry, with the attractions of old age, liaison and forensic psychiatry seemingly unassailable. My confidence finally reached rock bottom when a senior house officer announced that she no longer wished to continue in psychiatry because the role models we (consultants) set were unattractive. Apparently the image we project is of long hours, unlimited demands, endless risks and little time to practise the art of psychiatry. With the anniversary of my appointment approaching now it seems appropriate to consider why my hard fought for job has all the attractions of the plague.

Dean (2001) found conflicting views among consultant psychiatrists about ‘what is actually meant by having responsible medical officer (RMO) status'. Many clearly feel that they are responsible for virtually all patients referred to secondary care: Tyrer et al (2001) found in a large audit many consultants with big personal case-loads of 200–300 patients. They concluded that the statutory duties of a RMO needed to be revised to avoid consultants merely becoming bureaucratic administrators of their case-load’.