THERE was an outcry recently over the attack by Sir Paul Flynn on proposals to run routine health services on a seven-day-a-week basis as "catering for the convenience of the middle class". At first sight, it is the kind of remark one might expect from the NUT in full conference flight, not from the head of the British Medical Association's Consultants' Committee. But behind Sir Paul's apparent sneer is a raging debate about what constitutes professionalism in medicine.

Sir Paul fears that the Government is importing business models that are distorting the health service, and that doctors are increasingly managed by those who do not have patients' interests at heart. Others point out that not using clinical facilities at weekends is a waste of valuable resources, as well as a danger to patients. Sir Bruce Keogh, the Medical Director of the NHS, argues that a seven-day health service would be "patient-centred, compassionate, and convenient".

Those who support him would ask why a woman who has found a lump in her breast on a Friday has to wait through the weekend because most facilities are shut until Monday. And why are we so complacent about the fact that hospital patients are more likely to die at weekends because there are no consultants to see them?

Doctors are among the few professionals who are still held in high esteem by the public. They are highly trained and relatively well paid. GPs, in particular, did well under New Labour, when their salaries were increased and their hours were effectively cut. The issue for them now is what kind of professional freedom is compatible with the privileges that they enjoy.

Professionalism is about bringing specialised knowledge and experience to bear on complex human problems. It requires a constant updating of skills, judgement, empathy, and that elusive quality of wisdom, which tempers what is possible with what is right. To be truly effective, it must be accessible to those who need it - and that is the nub of the current argument.

Not so long ago, health professionals enjoyed greater autonomy. Although their hours were long, they commanded unquestioned respect. At home, most were supported by spouses who took it for granted that their husbands' work should come first. Times have changed.

Sir Paul wants to protect his members' interests, which is understandable. But professionals should earn the respect due to them by a willingness to initiate reform. If doctors really put patients first, governments might be less inclined to interfere.

The Revd Angela Tilby is Diocesan Canon of Christ Church, Oxford, and Continuing Ministerial Development Adviser for the diocese of Oxford.