ABSTRACTAs part of the 1989 NHS Review, the government made participation in audit compulsory for the medical profession. Prior to this time, medical audit had been fragmented, implemented by “top‐down”initiatives promoted by professional bodies as well as by localized “bottom‐up”exercises undertaken by committed individuals. The paper uses evidence gained from four case studies of the implementation of medical audit in acute hospitals post 1989, to argue that during the early stages of policy implementation individualistic tendencies have, to some extent inadvertently, been given their head. This has not resulted in stronger external management of medical activities, as the government appeared initially to intend, but rather in locally determined medical audit activity, focused on technical process and medical management. However examining medical audit in the wider context of the total package of NHS reforms and of concurrent changes in medical management, suggests that medical interests, and the individualism that is characteristic of medical organization, will become diluted and less segregated in the future.