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In this paper we are concerned with the study of the changing balance of power in the health care services between professionalism, unionism and the state within the British National Health Service. Our approach is macro-sociological and historical. Ours is a structural analysis in which we explore the importance of class and sexual divisions in relation to the formation of occupational associations and to modes of occupational control: specifically, professionalism and unionism. [ABSTRACT FROM AUTHOR]