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Let's just remember that one person's bureacracy is another person's accountability. If you're spending that much public cash then you need to have structures. It's not 'corporate concrete boots' but the requirement that you spend public money responsibly and accountably.

Culturally, 'independent contractor' status is really attractive for people who don't want to have to work with in a system and controls.

One side of clinical autonomy is that you can demand to do what you like for the patient in front of you without any concern for the sustainability of the system (the NHS) at all. And if you say 'No' to someone, rather than being big enough to take the responsibility yourself you can blame 'the system'.

I'm not saying that everyone is like this - but there are enough people like it to make this more than just a crude stereotype.