Clinicians should take a greater role in managing the health service, says a King's Fund report issued today.

One of the authors, fellow in health systems Anthony Harrison, believes that to date the overall quality of NHS management has been very poor.

'The clinicians have concentrated on interventions, and managers have not had the confidence to challenge them over the way the service is designed. We are identifying a critical failure in what the service is doing'.

He said nurses had identified that the management function was poorly performed and moved in to semi-managerial roles, but 'more doctors should be encouraged to do the same.

Perhaps they could follow medical training by doing an MBA.'

The 340-page report says 'the implicit trust in clinicians that has characterised most of the life of the NHS has largely broken down.' In response, it argues that instead of 'retreating into their shells' the professions should become more engaged with wider issues.

It also argues that the role of the centre has become 'incoherent and inconsistent', with growing central responsibilities combined with slimmed down and overloaded central institutions.