ABSTRACT
The move from a paternalistic system that emphasised the autonomy and expertise of the professional, as represented by existing representations of reflective practice, towards a more flexible and empowering model of practice is central to understanding the current transformations of health care. This new paradigm incorporates many debated elements, including notions of citizenship, choice and co-production (Coulter 2002; Cottam and Leadbeater 2004) which emphasise the quality of the relationship between flexible professionals and active and empowered patients. What we are witnessing are attempts at radical shifts in the distribution of power. These arise from pressures of cost containment and changing expectations of the public and professionals, as well as increasing understanding of effective care (Wanless 2002; World Health Organisation 2005).
