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Good morning. There’s been much disquiet expressed at the BMA conference this week about changes to the organisation and working patterns of doctors as the NHS struggles to cope with its ongoing financial pressures. More GP’s are retiring early and not being replaced. Many are wanting more time off. It’s all so different from when it was taken for granted that being a doctor was a vocation, a sacred trust. Hours were long but the satisfactions were great. The personal relationship between doctor and patient came first and the doctor could refer patients on without other bodies setting limits and criteria. Henry Marsh, a recently retired brain surgeon, wrote recently that ‘the feeling that there was something special about being a doctor has disappeared’. In his memoirs he describes movingly his conversations with those he operated on, recording his failures as well as his successes with searing honesty. He hated the fact that as the years went on he found he was spending more time in meetings than with his patients. Sadly, he ended his distinguished career in a bureaucratic row, angry that his decision to remove a tube from a recovered patient was countered by a male nurse who was following new guidelines. That clash between experience and the rulebook is only one of many problems in health care at the moment. I don’t think anyone wants to go back to the days when consultants were treated as gods. Doctors need regulating, for their own safety as well as ours. But they must also have a measure of discretion, and here, a one to one relationship is important. Once, when a small mistake was made in a report of a hospital test, I was touched when my GP rang me up and apologised unreservedly. The disquiet of the BMA reflects a wider concern about the lack of trust in those who hold positions of responsibility for others. That lack of trust seems to run through society at the moment and I wonder how much it has to do with a devaluing of the sense of vocation. A theologian once referred to vocation as the place where a particular person’s deep joy meets the world’s deep need. This has been important in religious life – but its true in other walks of life as well. Vocation is where what is particular about us is linked to the service of others. Henry Marsh’s technical fascination with surgery was matched by a massive respect for his suffering patients which developed through his career. The sense of vocation has not died. In the recent bombings in London and Manchester we saw doctors and other healthcare workers flooding in, summoned or not, all determined to do their duty in the hour of need. In the emergency they simply knew who they were and what they were for – and that’s surely what vocation is. Doctors need to be regulated but they also need to be trusted. And so do we all.