Dealing with Boundaries: Communities of General Practice and Implementation of Change

Abstract

The paper uses the theory of communities of practice to explore the effects of professional and organisational boundaries on the implementation of a service improvement initiative within and across primary care settings. It shows that in spite of epistemic and status differences, multiprofessional communities of practice can develop and professional boundaries between general practitioners, practice nurses and practice managers co-located in the same organisation can be successfully bridged without major tensions or conflict. While knowledge circulates relatively easily within these multiprofessional communities of practice, barriers to knowledge sharing emerge at the boundary separating them from other groups existing in the same organisation. The strongest boundaries, however, lie between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational communities of practice in the context of primary care may thus be problematic. This is likely to affect the implementation of the primary care reform currently implemented in the English National Health Service, underscores the importance of facilitation in addressing organisational boundaries, and suggests that inter-organisational learning, collaboration and knowledge sharing in primary care landscape should get more attention from researchers.