Governing UK medical performance: a struggle for policy dominance

In the UK, policy on the governance of medical performance is characterised by a continuing struggle between state and profession for control of the agenda setting, formation and implementation stages of the policy process. Since 1998 both sides have continued to produce policies in response to highly visible political pressures but have yet to agree on how those policies should engage as they are implemented at the level of the individual practitioner. For the state, clinical governance forms the lynchpin of its drive to increase managerial control over doctors and, for the profession, revalidation is seen as the means for ensuring the quality of medical performance whilst preserving medicine's historic autonomy. This paper analyses the course of this 7-year struggle and shows how in constructing and delivering policy, state and profession draw on quite different and separate sets of institutional structures and values. As a consequence, there is an unresolved competition for dominance and little engagement between the two policy streams.