Being told that New Ways of Working is a new way of working is not enlightening (tautologies are true but rarely helpful) but demonstrates the problem - it is whatever you decide it is.

Redefining the role of a psychiatrist is fine but Vize et al (Psychiatric Bulletin, February 2008, 32, ) provide another tautology - ‘a role that encompasses the full scope of the work in which psychiatrists could be involved’. What people do is whatever is decided they do but this statement does not give a new ‘what’.

New Ways of Working arose from a crisis in consultant recruitment, a mismatch between consultant expansion and training numbers (Reference GoldbergGoldberg, 2008); from perceived necessity, not choice, and as such it is a pragmatic business solution to a particular demand and resource problem, not better patient care. Changing roles is not new and was happening throughout medicine. Let's be honest, not grandiose.

New Ways of Working is now used to legitimise redesign of any sort with services being destroyed for business reasons. Is it person centred or organisation centred? To improve the lives of psychiatrists or patients? Ironically, we will soon overproduce psychiatrists under Modernising Medical Careers while facing an impending crisis of nurse shortage.

Alternative ways of working are essential because solutions to the problems of one person, service, specialty or point in time may not be the solution for others.

Vize et al must be clear not only what New Ways of Working is but also what it is not. Otherwise, it becomes whatever people, including primary care trusts and trust managers, decide it is. Everything is good because it is New Ways of Working. However, ‘new’ is not enough and ‘new’ is not necessarily good!