Using a variety of evidence the author documents the rise of general management, the application of new techniques to reduce medical costs and improve efficiency, and other methods to control use and evaluate clinical performance. The impact and significance of these developments is discussed, and illustrated in detail by original case study material and interview data about managerial strategies of rationalization and retrenchment. Rob Flynn describes new systems of monitoring, regulation and surveillance applied to doctors and health workers, and argues that these threaten established power relations and institutional arrangements, by elevating managerial concepts for efficiency above professional definitions of need and citizenship demands for unrestricted access on the basis of need. Measures to create an internal market in the NHS are also analysed, and he argues that current trends will intensify managerial influence and undermine professional medical power. The contradictions and complexities of changes in structures of control in the NHS are examined in connection with critical assessments of theories about state restructuring, and post-Fordism in the welfare st