General management in the NHS: three views from the trenches

Views from three general managers focus respectively on the impact of the Griffiths changes after five years; how 'success' in general management may be evaluated; and the changing nature of central-local relationships. At district level, the job of DGM has changed much more than was expected and the demands have greatly increased. These developments have resulted in increased satisfaction for the general manager and a desire to achieve results. 'Success' in general management is an elusive concept. There are many perceptions of success. For general managers, success may be reduced to a struggle for survival. Ultimately, success needs to be extended beyond short-term goals and to be concerned with shaping the longer term future. Central-local relationships have, in many ways, changed little. The major criticism of the centre by the service remains much the same as before the Griffiths reforms-the lack of central leadership and direction. Regions are perceived as part of the centre by districts and units. There is much to be done to make central-local relationships more creative and supportive.