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 `modernisation' agenda. The superficial consensus in support of lay participating array of ideologies and theoretical masks a con 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 he replaced by robust community based participatory action research models.