Medical dominance in a changing world: the UK case

This paper examines the governance of the medical profession in the U.K. As in many other countries, external and internal pressures have brought a shift in relations between the state and medicine. The context in which doctors practise has undergone radical change. In common with many countries, the U.K. has turned to competitive markets, and state-sponsored regulatory measures to boost performance. As a consequence, state domination of the health policy agenda has increased replacing a corporatist politics and doctors’ individual clinical autonomy has been reduced. Moreover, the existing system of self-governance is in question. It is argued that, nevertheless, there is evidence of different forms of accommodation. The medical profession continues to control a valued knowledge base, retains its social standing and is able to reap economic rewards. A more plural form of medical leadership may emerge better suited to assuring quality in patient care.