Personal injury solicitors across the land are suffering pre-surgery jitters, as many face a forcible separation from a traditionally lucrative source of work - legally-aided medical negligence.

Earlier this month, the government unveiled plans to exclude non-specialist solicitors from representing on legal aid people who claim to have suffered as a result of negligence by hospital doctors, GPs, dentists or other clinical practitioners.Solicitors hoping to practise medical negligence under the new regime will have to learn to live with change.

First, they must stop calling it medical negligence - it is now clinical negligence, a term more accurately reflecting the scope of the work.

More fundamentally they will have to learn to survive under the new franchise or stop working in the field altogether.

From the start of this month, solicitors have been able to apply for franchises from the Legal Aid Board (LAB), and from 1 August 1999 all legal aid applications in new clinical negligence cases will be restricted to franchised firms or applicants who have passed a preliminary franchisee audit.When the Lord Chancellor, Lord Irvine announced the new clinical negligence franchise last month, he told lawyers that clients wanted a 'quality-assured' service and not just the nearest solicitor 'doing their best'.

He said: 'People on legal aid who feel they have suffered because of negligence by clinical practitioners must be confident they have genuine expert legal help and advice on their side.

Restricting these cases to a group of highly competent, specialist solicitors will give people the best possible chance of resolving the disputes successfully.'Accompanying LAB figures made a sobering read for generalist practitioners.

Last year, the specialists won more than twice as much money in damages for their clients on average than non-experts.

For every £1 they cost the tax payer in legal aid fees, the specialists won £4.10, compared with £2.50 for personal injury solicitors and £1.70 for other solicitors.

Clearly for the LA B there are too many dabblers, and there will be a dramatic reduction in the number of practitioners.

According to Lord Chancellor's Department (LCD) figures, 3,261 firms claimed legal aid for medical negligence work last year.

LAB chief executive Steve Orchard said recently that there will initially be 170 franchises up for grabs.

To qualify, firms must be specialists - either members of the Law Society medical negligence panel or the Action for Victims of Medical Negligence (AVMA) panel.For many specialists, the move is long over due.

Thomas Osborne, a partner with Bedfordshire firm Osborne Morris & Morgan and assessor on the Law Society panel, says the victims of negligence have suffered badly at the hands of incompetent solicitors.

He claims that 50% of his firm's larger claims, including brain injury cases, are derived from cases taken over from other solicitors.

On the other side of the fence, Steve Walker, chief executive of the National Health Service Litigation Authority (NHSLA), also endorses the reforms.

The NHSLA recently slashed the number of law firms it uses for defence work from an unwieldy 98 to a manageable panel of 18.

From his perspective, plaintiff solicitors fall into two camps - the good ones are excellent but the bad ones 'have no idea'.However, there is alarm from some quarters about the government's plans.

Ian Walker, president of the Association for Personal Injury lawyers (APIL), is concerned that many experienced and competent practitioners will be excluded because they cannot satisfy panel criteria for trial experience - for example, the Law Society requires members to have dealt with at least 36 cases over the previous three years and three cases set down and ready for trial.

Alternatively, capable firms, he claims, cannot qualify because they have recently lost a panel member.

'There's got to be a wider view of how you test competence in medical negligence than this criteria,' he says.

Karen McKay, head of legal aid policy at the Law Society, shares his concern and also notes that, without a route into the medical negligence field via examination and not merely through experience, there might be problems in training new entrants to the speciality.Ms McKay also argues that 'lower value' work, which specialists might not have experience of or an interest in, may be neglected, and says that there could be a role for general personal injury lawyers to meet the excess work.The 170 firm limit has raised fears that some parts of the country will not be covered.

In May, the LAB unveiled a map of franchises, in which, according to Ms McKay, there was 'virtually nothing' in the north west, East Anglia and 'very little' in Devon or Cornwall.

However, earlier this month, Mr Orchard said he expected that no region would be beyond the reach of legal help.Arnold Simanowitz, chairman of Action for Victims of Medical Accidents (AVMA), is confident there will be a sufficient number of lawyers to do the work, adding that AVMA panel solicitors have always been prepared to travel across the country to do work.

'What you don't want is someone wandering into their high street solicitor because they are accessible, but they dabble in medical negligence,' he says.

The LCD has announced a campaign to raise public awareness of specialist lawyers, including freephone lines.Many practitioners fear that victims of clinical negligence will fare under the new regime.

Mr Simanowitz says franchised firms will be required to maintain a good case track record as part of the merits screening.

'[It] is aimed at ensuring only t he better cases are taken on, and that's right and proper.

But it shouldn't result in only certainties being taken on.

In medical negligence there are complex cases, and they must be investigated properly.' Ian Walker of APIL is anxious about the LAB's suggestions in its latest consultation paper to exclude claims under £10,000 from the scheme.

He says: 'I think it is worrying if people who are treated in a negligent way by the medical profession are not going to get access to the remedies unless they have lost half an arm.' The figure has now been reduced to £5,000.The government has remained silent on the future of clinical negligence under legal aid.

Many practitioners are worried that it marks the first step towards removing the work from its scope altogether.

However, Mr Simanowitz says it is also an opportunity for the profession.

He says: 'It seems we are going through all the steps to make sure medical negligence is done properly under legal aid; if we succeed in that - and I'm sure we will - what on earth can be the imperative to remove it from legal aid?'