NHS managers and the public are as guilty of stifling change as prime minister Tony Blair's 'forces of conservatism' in the medical profession, according to a leading supporter of the latest reforms.

In a collection of essays to be published by the Institute for Public Policy Research, Dr Tom Coffey, a London GP and member of the New Health Network, says health authority managers are loath to change. He acknowledges that organisations such as the British Medical Association can be 'innovative' and 'Luddite' by turns.

But he says primary care groups should be freed from HA debt so GPs can innovate since GPs 'are certainly a better bet, as drivers of change, than professional managers within the NHS'.

'GPs complain that HAs block change and are rarely proactive. It would be surprising, therefore, to find an organisation on the brink of extinction calling for change at a faster pace.'

But Dr Coffey says the public 'fights tooth and nail to keep their local hospitals and ultimately thwarts the improvement of local healthcare'.

The Forces of Conservatism . IPPR, 0181-986 5488.£7.50 (published 6 December).

See comment, page 15.