Abstract
Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation to the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and general practitioners—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest.
Highlights
Traditional ways of organizing health care and other public services are coming under pressure from governments globally, who see them as increasingly ill-suited to contemporary economic and social exigencies
Is as much about the renegotiation of professional boundaries as the legitimation of existing jurisdictions. We address another lacuna in the sociology of the medical profession, by focusing on an intra-professional division within medicine—between newly appointed general practitioners with a special interest (GPSIs) in genetics and existing specialist genetics consultants—rather than the boundary between physicians and other professions
Under „Negotiating a role‟, we set out the plans of GPSIs in each site, and how these were negotiated with geneticists. „Delimiting the GPSI knowledge base‟ considers the divergent views of those involved about exactly what kind of knowledge GPSIs could accumulate and put into practice in their „sub-specialist‟ roles, and the role this implied vis-à-vis their specialist peers. „Towards jurisdictional closure‟ looks at how such divergent discourses were reconciled, as boundaries between the sub-professions were reasserted
Summary
Traditional ways of organizing health care and other public services are coming under pressure from governments globally, who see them as increasingly ill-suited to contemporary economic and social exigencies. The literature on the health professions concentrates on potential, rather than actual, shifts in professional boundaries: it considers legitimacy claims in isolation, rather than in relation to specific challenges to the professional division of labour. Our findings relate to the legitimatory strategies deployed by those involved—the mainstay of the sociology of the medical profession—and to the interaction of these with wider power structures in the modernizing NHS to create new (or reproduce existing) professional boundaries. Is as much about the renegotiation of professional boundaries as the legitimation of existing jurisdictions We address another lacuna in the sociology of the medical profession, by focusing on an intra-professional division within medicine—between newly appointed general practitioners (family physicians) with a special interest (GPSIs) in genetics and existing specialist genetics consultants—rather than the boundary between physicians and other professions. Given the ubiquity of the division between primary care-based family physicians and hospital-based specialists globally (e.g. Shortell, Gillies, Anderson, Erickson & Mitchell, 2000), and efforts in the UK and elsewhere to move knowledge and power towards primary-care practitioners, the outcome of this negotiation is of wide interest
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