Doctors, managers and politicians

Doctors and politicians have rarely seen eye to eye on what a health service should provide and how it should be managed. The introduction of general management in 1984, while initially successful, created new fault-lines between doctors, managers and politicians that were compounded by a succession of NHS reorganisations. These changes brought politics too close to front-line management, highlighted the incompatibility of managerially determined targets with the essence of professional practice, and have led to the development of a management agenda disconnected from healthcare. Remedies are suggested here that reflect the particular roles and contributions of each group that could restore a sense of shared purpose in the running of the NHS.