Preventing incompatible transfusions

rather than simply as "highly paid producers of services to be managed like a collective bargaining unit" (as Henry J Kaiser first considered the doctors he hired to provide medical care for his California shipyard workers during the second world war").The Kaiser Health Plan currently offers several million members medical care on a prepaid basis and resembles the NHS in many ways.How a balance of authority and responsibility between doctors and management was fought for and achieved may be of special interest during current efforts to reconcile conflicting interests in the NHS.II Intentions have been expressed and first steps taken.The government states that doctors should participate in manage- ment decisions, and doctors' incorporation as participants in clinical directorates has been debated extensively.'2What remains to be completed is a clear formalisation of lines of authority and responsibility which recognise doctors as equal partners in a collaboration based on respect and trust in pursuit of a mutually agreed objective.7Only then will it be possible to achieve the full benefits that such a partnership can offer to the British public.