ABSTRACT
In Chapter 2, I described a little disagreement I once had with a practice manager about the accuracy of information our CPN department were supplying. I was irritated by the obsession with receiving quantitative information and the apparent disregard for the quality of the work. This was against a background of increasing market forces in the NHS. Trust status for health authorities, followed by fundholding status for GP surgeries, seemed to bring out the worst in some health care workers. One GP, in the forefront of fundholding autonomy, angrily expressed his belief that the policy of encouraging patients on lithium to attend our local day hospital’s lithium clinic was an example of the consultant psychiatrists’ empire-building. In this competitive atmosphere, primary and secondary care workers often become polarised, blaming each other for being too inflexible, or not productive enough, or not communicative enough, or not accurate in their giving of information.
