Milburn should be wary of alienating doctors ahead of the election

It is a brave government that takes on the medical profession just weeks from an election, particularly when the subject of dispute is their contracts. Former health secretary Kenneth Clarke must still squirm occasionally about some of the things that were said about him when he forced through the 1990 GP contract.

Few doubt that the consultants' contract, unchanged since the NHS was founded, is in need of reform. The NHS plan signalled very clearly the route the government wished to take to ensure that the most experienced doctors didn't duck their responsibilities to the NHS for the lure of the private sector.

Equally, few can argue that formalised job plans setting out the responsibilities of individual consultants, and rewards for commitment to NHS work, are laudable. It makes sense that those initial years as a consultant are devoted solely to NHS work - an opportunity to consolidate expertise and to give something back to the service.

But it is this idea of a seven-year commitment to the NHS which still rankles for the British Medical Association - and the medical profession never takes kindly to being told what to do by non-medics.

Health secretary Alan Milburn and his colleagues, buoyed by reassuring opinion polls, probably feel encouraged to challenge the doctors, no matter how much noise they make. Sandwiched between reports on Alder Hey and Bristol, ministers may expect considerable public support for trying to raise the standards of care in the health service while rounding up those who spend half their week on the golf course. A few billion towards the hospital building programme probably guarantees enough positive local paper headlines and public backing to drown out consultants crying foul because they are being asked to spend more time on NHS work.

But doctors are still the backbone of the NHS and there is a fine line between the public losing confidence in them and losing confidence in the service itself. Delivering the plan's targets depends on the goodwill of all those working in the NHS as well as a desire among many more young people to opt for a career in the health professions.

Setting doctors against managers is another risk. Many trusts are still struggling to overcome the suspicions and resentments between clinicians and managers. To force managers to dictate the workload of reluctant consultants could create rifts that would take many more years to heal.

Understandably, ministers may sense that they need to clear the decks ahead of an election and to hasten the end to talks which have seen little progress since the original proposals were put forward last July. But they should tread with caution - better, surely, that the medics feel they are being listened to than to have the recriminations of the BMA echoing throughout the hustings.