In two weeks' time the next wave of major change will hit the NHS with the launch of primary care trusts, a new type of health service organisation. They will unleash forces in the system which will inevitably affect its dynamics: even areas which do not have a PCT will soon feel the effect. In particular, life for health authorities and community trusts will never be the same again.
But PCTs contain within themselves the seeds of potential conflict, not least in their confused accountability structure. Many a PCT chief executive may have an uncomfortable experience working with the executive board, chaired by a doctor or nurse and responsible to the trust chair.
Never since the chief executive's role was introduced into the service has it been so constrained. It looks like a throwback to the days when the professions dominated management teams served by administrators. Can it survive?