ABSTRACT
Doctors have traditionally enjoyed much freedom to practise in the way they consider appropriate. Hospital consultants’ clinical autonomy derived from what was, in effect, a bargain between the state and the medical profession whereby ‘central government controlled the budget, while doctors controlled what happened within that budget. Financial power was concentrated at the centre; clinical power was concentrated at the periphery’. The Griffiths report also argued that hospital doctors ‘must accept the management responsibility which goes with clinical freedom’. The internal market inaugurated by a Conservative government in the early 1990s extended the management responsibilities of general practitioners too. Various factors have inhibited cultural change; in particular, the continuing lack of a single set of dear managerial objectives. Recurring themes are media outrage about senior pay, allegations of too many managers and the perceived role of National Health Service (NHS) leaders in failing to resolve major incidents.
