Unfortunately, bullying is difficult to define. We all smile at the creative use of language: 'I am firm, you are a disciplinarian, he is a bully.' Clearly, managers in any organisation have to achieve order, apply rules and take tough decisions - but where do we draw the line?

Bullying is where the will of one person is forced on another in such a way that it leaves them feeling vulnerable, upset or hurt. Bullies impose themselves on their victims without being prepared to see their point of view; or use their power or position deliberately to inflict pain, either emotional or physical.

Sadly, bullying still occurs in the professions: we all know of consultants who browbeat their juniors and sisters who terrorise nurses.

Managers are no better: the recent report on the Mid Staffordshire hospital debacle states that nursing staff felt bullied by managers more interested in fulfilling targets than in the welfare of patients.

Bullying isn't carried out just by individuals: groups and organisations do it too. When the DoH unilaterally changes an established contract, this is bullying. When PCTs impose extra rules on GPs without bothering to consult them, this is bullying. When PCTs imply that any failure to accede 'voluntarily' to their demands will result in your practice being deprived of resources or funding, this is bullying.

Although institutionalised intimidation seems to occur in PCTs and hospitals, SHAs do their fair share - for example, when they forced PCTs to retract their existing proposals and instead offer only below-cost payments for swine flu immunisation.

Not every NHS organisation behaves like this. Many individuals and groups are of the highest probity. But there is a widespread culture of bullying within the NHS: sadly, we have all become accustomed to it. Yet were this behaviour racially motivated it would immediately be denounced as unacceptable.

Why is bullying so widely ignored within the NHS? And what can we do about it? More next week.

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