Most people live a paradox: their lives could be defined as a series of change events leading to the one thing which is absolutely certain – death. Yet most of us live life in such a way that we deny death and pretend that security, prosperity and health are forever. Many organisations have behaved in the same way. Until, that is, the advent of the six forces which began to change the form and self-perception of most organisations, including the primary care sector, over the last two decades. These forces, which have induced a kind of mid-life crisis in most organisations, were:

globalisation and its twin, new public management

customer power

investor power

information technology


the drive towards fewer layers of management.