The liberal-democratic theory of political representation, whereby political parties and mps are regarded as the sole vehicle of political ideas and programmes, has given way to a more realistic view of a system in which pressure groups are regarded as a sensitive section of the machinery for the selection of issues and for ensuring the responsiveness of government. Consultation with pressure groups in the process of policy-making has a long history in Britain, dating back to the late seventeenth and early eighteenth centuries. Sectional ‘spokesman’ and promotional groups enter the preparatory stage of legislation in different ways, and at a number of levels. After the 1946 act had been passed, a crisis of confidence arose between the minister of health and the medical profession, directly attributable to the failure of the ministry to consult with the association at the preparatory stages of the nhs Bill.