Government directives and changes: the potential impact on clinical practice

Since publication of The new NHS: modern, dependable we have had more guidance and circulars from central government than have ever before been received in such a short space of time: 242 in 1998 and already well over 100 in 1999. Furthermore, 'joined-up government' may not have been achieved yet, but it certainly means that all agencies are being changed or modernised simultaneously, and so are all in the same position. This paper examines the impact that some of these directives and changes may have on clinicians and clinical practice. The paper does not deal with the issue of setting up primary care groups (PCGs), which could form the basis of an article on its own.