Clients or citizens? Some considerations for primary care organisations

Health services policy in the United Kingdom has given prominence to patient and public participation within a 'modernization' agenda. The superficial consensus in support of lay participation masks a conflicting array of ideologies and theoretical perspectives that colour how this is interpreted. Both client-oriented perspectives and citizenship-oriented approaches are limited by the dynamics of power relationships and decision-making processes within National Health Service structures. Primary care organisations offer the possibility of developing structures for providing closer collaboration between citizens and services. In order to achieve this, however, vague processes of client representation need to be replaced by robust community-based participatory action research models.