The managed care enterprise is most definitely on the move. With powerful sponsors, especially in the pharmaceutical industry, its rapid development is a contemporary global phenomenon. Just as in the last chapter we cited modern primary care organisations in the UK championing the cause of Relational Health Care through extended general practices, so too it would be easy now to find as many advocates among the same fraternity of the managed care enterprise. Indeed, the latter figures rather more prominently in, for example, the NHS Director of Primary Care’s recent national Progress Report, 1 with frequent references to primary care trusts that have adopted and adapted managed care protocols and procedures from the likes of EverCare and the Kaiser Permanente Foundation in the US. At times it can seem that the movement towards managed care is irresistible, not least as we have noted in developing countries where resource shortages are such that donor dependency on the West has been virtually absolute (see pp. 1–6).