In 1976 it was suggested to the King's Fund by a group of younger hospital doctors that it might be valuable to take a fresh look at the organisation of hospital clinical work and those responsible for it. A working party was established to consider ways in which medical manpower could be more effectively deployed and used. Discussion covered the relationship between the work of hospital-based doctors and GPs and also the problems of hospital career structure and medical manpower planning. This report aims to offer a strategic framework to improve the organisation of clinical practice, clarify accountability and lead to better balanced career structures.