The requirements of the new deal for junior doctors' hours has meant that many smaller trusts are unable to provide adequate cover on-call for medical and surgical subspecialties. The care of the acute subspecialty patients has, therefore, shifted to general teams in many trusts. We assessed what impact this had upon the outcome of acute urological cases in our district general hospital by prospectively monitoring acute renal colic admissions over a 12-month period and surveyed the provision of services in other regional hospitals. The shift in care of the acute urological patient was associated with considerable morbidity for patients admitted in our hospital. The additional financial burden due to this morbidity was estimated to be 33000 pounds/annum. The implementation of the new deal must be achieved with every care to minimise the clinical and financial costs of withdrawing acute subspecialty services.

The acute presentation of a Type 1 (insulin‐dependent) diabetic with a metabolic acidosis does not usually present diagnostic or therapeutic problems. A case of diabetic ketoacidosis is described, in which the coexistence of a bladder operation led to further, severe electrolyte disturbances. Chronic depletion of body buffer stores resulted in a tendency to acidosis in an otherwise stable diabetic, which accompanied profound electrolyte disturbances.

The training of junior doctors in the UK is undergoing an evolution to ensure that those concerned are adequately trained and specialised for current and future consultant practice.The implementation of this training evolution is currently widespread at the foundation level (SHO-equivalent) and will expand to specialty training programmes as foundation programme trainees complete their training in 2007. Urology has led the change to the specialty training, with three-year trainees having entered the specialty in 2005. The emergence of urology as the lead specialty for change originated in part from a meeting in 1998 that addressed the future of urology and training, the summary of which was published later that year. The urology consultant workload is undoubtedly changing with the expansion of diagnostic services and the decrease in surgical in favour of medical treatments. The proportion of patients currently referred for surgery after an outpatient consultation has decreased and trainees are exposed to 50% of the operative experience of a decade ago.