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    So, what do you think happens now? Several layers of inefficient management pass a series of bits of paper between themselves and then agree to do something that someone else then decides not to do because there is a pre-existing contract that the others didn't know about. Your way is better?

    I should add that not all managers are inefficient, and there are some pockets of proper excellence! I sometimes give the impression that I hate the NHS - I don't, I respect and value it, and the people working in it. It is for that reason that I get cross with the others!!!!!

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