The doctor-manager relationship: a behavioural barrier to effective health care?

The National Health Service (NHS) is a huge and complex organisation. Within it, acute Hospital Trusts operate within a range of constructs determined by central Government. Organisational success is measured against rapidly changing frameworks of standards and targets. The Griffiths report signalled a perceived shift away from the professional autonomy of clinicians, towards general management systems. This resulted in tension between those responsible for delivering the Government's broader health agenda, and those driven by a desire to directly care for patients.