Managing without doctors: realities of Griffiths.

Medical influence on health service management at district level could be eroded as the new Griffiths management arrangements are introduced by district health authorities. Most districts are changing the composition and functions of the district management team to accommodate their new general managers. District general managers are required to prepare new management arrangements for their districts, implementing the philosophy of the Griffiths report.' These proposals are submitted by district health authorities to the regional health authorities and the Department of Health and Social Security for approval. In many districts this task has been completed and the new management arrangements are being implemented. Most other districts have submitted plans to the regions and the DHSS and are awaiting approval. The idea of a district management team was strongly supported by the much maligned "Grey Book," which laid down a blueprint for the 1974 health service reorganisation.2 The district manage-