The Griffiths report of 1983 resulted in radical changes (to which the label ‘general management’ has been applied) to the formalities of organization and management in the national health service. We report the findings of a major study (involving more than 300 interviews) of the impact of these changes up to 1988. Although general management has been widely accepted in the service, and seems to have resulted in some improvements to management processes, there has been no substantial change in organizational culture. We conclude that the impact of the Griffiths model of management has been limited in comparison with the continued influence of medical autonomy and financial limitati