improve their administration, and some GPs had even sought to explore general practice in terms of management theory. 114
Developments within British medical discourse and practice were also of importance. Psychologically oriented theories emerging in the late 1950s emphasised professional fallibility and reflexivity, whilst the NHS's close connection with research saw major figures in British clinical and healthservicesresearch promote techniques of review as central to efficiency and efficacy. 115 In fact, some doctors saw diabetes as a site
professionalism? And what do more recent developments indicate about the shifting relationship between professionals and the state?
As the foregoing history of diabetes management shows, medical professionals in Britain were rarely united in the post-war period, and new forms of activity embodied in chronic disease care and professional management were contested. Like those in the USA, British academic clinicians and healthserviceresearchers, although often involved with teaching hospitals, assumed new managerial roles over medical practice when creating
ultimately hollow because of the concessions made to form the NHS. Already in the 1950s, central departments wanted to exercise some control over service expenditure, even if this infringed upon clinical decision-making. 49 Considerations of costs were shared by some elite GPs and emergent healthserviceresearchers, who progressively problematised variations in prescribing and speculated about accountability for resource use. 50 Nonetheless, the NHS had been founded on an informal agreement that doctors would have considerable autonomy of action within set budgets. 51
publications and projects on retinopathy and its detection and treatment. 96 Foulds's paper, however, was the first substantive piece of work seen by officials that drew together large-scale investigation of prevalence and incidence with costed comparisons of tests, screening staff, and equipment. 97 One medical civil servant who received the paper even suggested that it was ‘one of the most exciting [papers] in practical terms I have seen in some time’ and exactly ‘the sort of healthservicesresearch we need more of’. 98
To some extent, the paper
institutionalised disciplines, such as health economics and healthserviceresearch, that took the delivery of care as their object of study. 22 Academic units in York and London, as well as think-tanks like the Office for Health Economics, became sites for raising questions about large variations in healthcare, in part building upon epidemiological studies of variation in diagnostic testing and interpretation. 23 Contributing to longer-term trends in the standardisation of categories and techniques of investigation, these disciplines problematised clinical decision-making and