During the last two years, the medical profession in Britain has been participating in a public debate – perhaps in a more exposed way than for some time. Eminent Presidents have been writing letters to The Times, and less eminent ones demonstrating in Downing Street. This can all be seen as contributions to the discussion on the state of the National Health Service. But there is, I believe, a wider and in my view a more long-lasting change going on, namely the relationship between the medical profession and the public – the citizens of this country. You may feel that the basic premise is based on a false dichotomy, rather like the sterile debates on community care. Hospitals are part of the community. Doctors are citizens. Yet there is an implicit or explicit contract, social if not financial, between a country's medical profession and its citizens. As we are in the era of negotiating or inventing or specifying contracts, I wanted to consider this.