ABSTRACT
The period of General Practitioner fundholding can seem like a remarkable act of faith on the part of government. Trust was genuinely placed, in both its organisational and ethical senses, in the units furthest removed from the centre, closest to the client coal face; and then the distance and the real freedoms that went with it were actually increased through extended powers of self-regulation and direct purchasing. For better or worse, traumas are often turning points. The suffering involved can clear the way, divorcing the past from the future. The second reason for encouragement is that good management is being recognised as an intrinsic component of clinical improvement. What has been described as the skills of really managing healthcare are being rediscovered. The essence of these skills is the facilitation of right relationships with what lies termed the ‘generosity’ and ‘discipline’ they require.
