There is much to be said for direct state organisation and remuneration within a system of legal representation in criminal law.

The parallels drawn with the NHS by Paul Roach in his recent comment article are valid (see [2003] Gazette, 29 August, 14).

However, as a medical consultant in the NHS there are aspects of this infrastructure that are best avoided.

GPs are overburdened with regulation of work practices and monitoring bureaucracy, and littered with targets.

There is a high level of disillusionment by patients and clinicians.

Hospital consultants have similar problems with an emerging theme of restriction of what they do in their own time should they wish to earn money by undertaking private practice.

Perhaps the central point is that a benign system wishing to foster a service, medical or legal, can do so irrespective of the infrastructure.

Equally, where a government wants to regulate, subjugate and demoralise a professional group they can manage it, however that group delivers its services.

David de Berker, Consultant Dermatologist, Bristol Royal Infirmary