Abstract
The NHS in the UK continues to undergo rapid reforms incorporating New Public Financial Management techniques with limited attention only given to the theoretical underpinning and practical limitations of participatory health choice and evaluation. The study adopts a reflexive approach to realizing the aim of implementing empowering social audit—a paradigm founded in a polyvocal citizenship perspective (PCP). The paper explores the ethical dilemmas in implementing social audit in Primary Health Care. The research follows on from consultation with patients to reflect on concerns of accountability, patients’ interests and values. Democratic participation and informed choice are inextricably bounded by the existing economic, informational and power relationships. These potentially constricting factors are discussed using the illustrative case of generic prescribing. Patients preference for voice participation and their affirmation for “accountability" (albeit under-defined at present) should encourage engagement with a community development approach for new social accounting and social audit.
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