The GTC Management in Medicine (MiM) programme is designed to help doctors and other clinicians in training develop their management and leadership skills. The first seminar of the new academic year looks at the NHS and will explore participants’ understanding of the current structure of the organisation and look at how it came into being, how it was originally managed and operated and the series of significant structural changes that has been an important characteristic of its sixty-seven year history. It will also explore the innumerable political and financial challenges currently facing the NHS.