Following the recent reorganisation of the health service, doctors have been advised to accept the challenge of involving themselves in general management, (Ross, 1991), and the need for additional training in management skills has been recognised (Higgins, 1989; CTC Working Party Report, 1990). Local trainers, however, often do not know what sort of management training is appropriate, nor how or when it should be introduced into an eight year specialist training agenda, and the current situation for many trainees may, therefore, be described as hit or miss (Lock, 1991). Trainees need also to learn to consider not only their immediate clinical responsibility to individual patients, but also the broader concepts of preventive and public health medicine and the principles of equity, efficiency, quality and efficacy which underly the purchaser-provider contractual process.