One NHS reorganisation too many: time to move on

Most British doctors are not affected by NHS reorganisations. They manage to concentrate on caring for their patients, despite the surrounding upheaval. Many GPs and consultants don't know what the current NHS structure is or what a primary care trust or strategic health authority does, and to them it probably doesn't matter. It is different for public health doctors: they are invariably affected and are often required to move into a new organisation. Many years ago a wise medical director told me that as a “punishment for joining NHS management” public health doctors have to regularly reapply for their jobs.

I was a director of public health in three health authorities, none of which now exist. I always believed that the value of public health skills and knowledge, once recognised, would guarantee that boards and colleagues embrace and implement good public health practice. Doing so became harder and harder over the past 10 years.

Contestability confronted professional protectionism

In 2002 we implemented the proposals in the NHS's Shifting the Balance of Power policy in response to concerns that patients, the public, and frontline clinicians had too little …