It has been six months since clinical negligence practice went under the knife, and the government announced it was to limit legal aid work to 170 specialist firms out of more than 3,000 that had previously claimed funding.For the 5% of firms that survived the chop, the prognosis looks excellent.

Not surprisingly, they are busier than ever.

Firms have been recruiting like mad and accident victims are getting better legal advice than ever before.The Lord Chancellor, Lord Irvine, at the launch of the clinical negligence franchise in October 1998, said he wanted a 'quality-assured service' and not, simply, the nearest solicitor 'doing their best'.

'Restricting these cases to a group of highly-competent specialised solicitors will give people th e best possible chance of resolving disputes successfully,' he claimed.The statistics provided by the Legal Aid Board (LAB) made a compelling case for change.

For every £1 clinical negligence solicitors cost the taxpayer in legal aid fees, the specialists won £4.10, personal injury solicitors won £2.50, and other practitioners won £1.70.

Initially, the LAB's chief executive Steve Orchard proposed that there would be 170 franchises up for grabs, but now that number has been upped to 282.

In 1998, 3,261 firms claimed legal aid for medical negligence, as it was known then.

To qualify, firms must be 'specialists' -- either members of the Law Society's clinical negligence panel or the Action for Victims of Medical Negligence (AVMA) panel.There was considerable sympathy from practitioners to the funding reforms.

Thomas Osbourne, a partner with Bedfordshire firm Osbourne Morris & Morgan, was reported as saying that 50% of his firm's larger claims, including brain injuries, came from cases taken over from other solicitors who were unable to complete the work (see [1999] Gazette, 18 November, 10).Solicitor Arnold Simanowitz, AVMA's chairman, has been arguing for 15 years to keep the dabblers out of clinical negligence.

He reports that, post-franchising, there is a clear evidence that claimants are getting a better deal.

Common examples of unprofessional behaviour -- cases being dragged out 'for years', unnecessary investigations, and instructing the wrong experts witnesses -- are being cut down.Ian Walker, president of the Association of Personal Injury Lawyers (APIL), says few would argue that this was the kind of work that should be done by generalists and 'to that extent' franchising seems to be working well.

On the other side of the fence, solicitors representing the defendants also acknowledge a change for the better.

Gary Allison, head of the medical unit at insurance litigation firm Berrymans Lace Mawer, says he has seen 'a consistently higher standard' in the way in which claimants' cases are presented, which has been of 'enormous benefit' to defendant solicitors like him.

Before, the work could be 'very variable', he adds.Martin Staples, president of the Forum of Insurance Lawyers (FOIL), is less impressed.

He knows the theory, but he has not noticed a huge amount of difference in practice.

The success of franchising lies in the perception of the LAB and its ability to identify the right firms, he says.

Also, he says that those practitioners from firms without franchises are seeking positions in practices which are franchised.Life is certainly becoming busier for clinical negligence specialists.

According to Lesley Herbertson, who heads up the clinical negligence team in the Altrincham office of top claimant practice Alexander Harris, the firm is receiving 150 new enquiries a month.

Alexander Harris last year opened up a London office and has taken on another three members of staff elsewhere.

It is also a time for opportunism; one specialist firm is reported to have sent out a circular letter to excluded firms selflessly offering its services to take over cases.But there is a cause for concern, says APIL's Mr Walker, as the franchising regime does not provide for future growth in the profession.

It is a Catch-22 situation, he says.

'If you are not with a firm that has a franchise, you are not going to get the work, you're not going to get the experience and the whole thing will not grow,' he says.

But you need the work and experience to get a franchise.

Russell Jones & Walker, where Mr Walker is senior partner, has taken on five new staff in the past six months and he reckons that its workload has increased by 25%.But there is also pressure from the LAB limiting the amount of money firms receive to start up cases.

According to Ms Herbertson, rather than having £7,500 from the LAB to start a case, that has been limited to as little £2,500, which means practices are having to increase efficiency.

'You get to the point straight away,' she says; but she adds that practices can only do that if the correct systems are in place.

Before taking on a case, a careful analysis -- including, perhaps, the commissioning of medical experts -- has to be done.Sarah Goodman, a partner at claimant personal injury firm Thompsons, says the way in which work is being undertaken is going through a 'radical' change.

Alternative means of funding cases has led to firms seeking more innovative approaches.

Outside of legally-aided work, there are the smaller actions where 'you have a hunch and go for it', she says.The firm is also looking at legal expenses insurance to back conditional fee agreements (CFAs).

However it is early days for CFAs, and she points out that solicitors have to complete a considerable amount of preliminary work before insurers are prepared to quote a premium.

Ms Goodman says this has the knock-on effect of solicitors having to be flexible on risk assessment and advising clients.

'Risk assessment is paramount from the moment that the client walks in,' she says.Thompsons has a large trade union client base, and union clients are looking at ways to produce packages for low-paid members who do not qualify for legal aid but cannot afford to cover the groundwork required by the insurers.Ms Herbertson believes that the insurers are not ready to handle clinical negligence work.

'The market place at the moment is getting worse and not better,' she says, 'and premiums are going up rather than coming down.' Ian Walker says that CFAs have not yet taken off, but expects that they will receive a boost when, under the Access to Justice Act 1999, premiums becomes recoverable.Last month, the government published its response to its consultation paper on conditional fees, Sharing the Risk of Litigation, and, undeflected from its course, set a 1 April implementation date for making success fees and insurance costs recoverable.

FOIL's Martin Staples has grave concerns about the proposals.

Earlier in the year, he accused the ministers of 'not living in the real world' if they did not acknowledge that CFAs would result in some claimant solicitors 'lining their own pockets'.

He argues that there is nothing to stop solicitors claiming 100% of the success fee -- the extra that can be charged by solicitors on CFAs -- every time.Last year was the year of the Woolf reforms, and nowhere has their impact been felt more than in personal injury and clinical negligence work.

The reforms continue to foster an atmosphere of co-operation and openness, says Ian Walker, especially the introduction of the clinical negligence pre-action protocol which has lead to many cases settling at an early stage.

Ms Goodman reports that part 36 offers (offers to settle and payments into court) are having a similar effect.

Claimant solicitors can make a 'pre-emptive strike' by making an offer to settle and defendant solicitors are becoming more realistic about the cost of taking cases all the way, she says.But of course there are greater factors at play outside of professional concerns keeping clinical negligence solicitors busy, such as the National Health Service.

Constant 'NHS in crisis' headlines -- from stories of bed shortages and 'flu epidemics to the patient who had the wrong kidney removed -- cause patients to question their doctors.

It is not that a lot of people have had bad treatment necessarily, says Ian Walker, but they no longer have confidence in their treatment.