General management and medical autonomy in the National Health Service.

Clinical freedom is an elastic concept and its practical meaning to clinicians varies with time and context. Management pressure on clinical freedom is also likely to be elastic. Resource constraints are increasing pressure on clinical freedom. The paper reviews the nature of such pressure and considers the extent to which general managers have successfully eroded medical autonomy. Drawing on emerging evidence from research in progress on the impact of general management, the paper concludes that there is little sign of change in doctor-manager relations. They continue to inhabit a shared culture of medical autonomy in which only rarely do managers challenge clinicians.