In England, the quality of clinical work is being regulated in new ways following recent developments in “clinical governance” policy and apparent failures in the previous system of medical self-regulation. Using multiple case studies, this paper examines how these changes are affecting professional governmentality and discipline in general practice. Formal organizational structures play little role in clinical governance there. Clinical quality is managed largely through semi-formal networks, relying on medical self-surveillance. Compliance is achieved largely by discursive appeals to the legitimacy of clinical governance, but local GPs’ leaders also argue that governments might otherwise regulate medical practice more actively. As yet the effects of clinical governance activity on service delivery are slight. Professional self-regulation is replacing permissive exception management with more collegial, directive methods.