Medical autonomy in the United Kingdom has declined over the last twenty-five years, whether considered at the micro level (such as control over treatment and work patterns), the meso level (in terms of corporatist relations with the state) or the macro level (in terms of the ‘biomedical model’). After a period in the early 1990s when the National Health Service displayed a mix of Fordist and post-Fordist controls, the emphasis has swung sharply towards the former, suggesting the continued explanatory value of theories which focus on the state's need both to contain welfare expenditure and to maximise the political legitimacy derived from it. The analysis of this relatively narrow area of sociology has implications for the study of much broader questions about the capacity and legitimacy of the state in the twenty-first century.