A quiet revolution due to take place across university hospitals will fundamentally change the relationship between doctors and managers in the NHS.

The creation of academic health science centres will place doctors firmly in charge of strategic direction and service development.

While Monitor's introduction of service line reporting could do more to accelerate the development of doctors in leadership roles, establishing academic health science centres will have a far greater impact on how healthcare organisations develop their strategies, structures and cultures.

The purpose of academic health science centres is to establish closer relationships between research, patient care and education. Other key organisational features are integration and flexibility in the use of resources, coupled with a strong emphasis on developing the quality of research.

Implications for managers

Establishing academic medical centres will have many organisational implications, for example the extent to which universities and NHS trusts will begin to merge their operations.

Another obvious implication is that leadership and management will become more complex and challenging. For many managers, understanding the context in which research-driven clinical services operate will be demanding.

For career managers, probably the biggest implication is that creating academic health science centres will fundamentally shift the power relationship between doctors, scientists and managers.

To be organisationally successful, NHS clinicians and university researchers will have to be firmly in charge of strategically developing and delivering their service and research objectives. The role of the general manager will be to facilitate the delivery of objectives under the leadership of clinical and research staff. In short, leadership and management roles will be much more delineated between doctors and managers.

Although these changes are likely only in a handful of centres across England, similar changes to the medico-managerial arrangements in all university hospitals are unlikely to be far behind. And, in a reflection of the history of developments in university hospitals, we should not be surprised to eventually see a ripple effect across the management arrangements of district general hospitals.

Unlike many other changes seen in the history of the NHS, this change will be real and long lasting.