Health minister Alan Milburn wants to see 'a new sense of self-confidence' among NHS managers.

In an exclusive interview with the Journal he said ministers were now actively considering what had to be done 'to properly develop managerial capability' in the new NHS.

Mr Milburn said that he wanted managers to be seen as a 'national force'.

They had an opportunity to shape the structure of the service, but Labour's reforms called for different skills to those needed under the internal market.

He expected the service to develop its existing managers, rather than to recruit from outside.

Mr Milburn revealed that he was prepared to be flexible about the size of populations covered by primary care groups, as long as they were based on 'natural communities'.

'I don't expect to see any health authority artificially drawing lines on a map. Nor do I expect to see groups of GPs carving up their territory. Neither is acceptable.'