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Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service userÕs experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice.

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Objective To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively.

In this article the authors report the findings of a study of satisfaction, dissatisfaction and complaining, funded by the National Health Service Executive (NHSE). Although interest in these issues has increased with the introduction of the Citizen's Charter Initiative and the continued growth of consumerism, few scholars have looked at the relationships between them. Satisfaction and dissatisfaction are commonly viewed as different facets of the same phenomenon. In turn, dissatisfaction is often understood to be a precursor to a complaint, or an embryonic one. The findings presented here suggest that satisfaction and dissatisfaction are linked but are essentially discrete constructs. The authors plot a variety of reactions to dissatisfaction and show that although excessive use is made of formal professional networks, few instances of dissatisfaction emerge as formal complaints. The article concludes that insufficient attention has been paid to understanding the everyday ways in which people cope with dissatisfaction and decisions not to voice a grievance.