Beyond professional boundaries: relationships and resources in health services' modernisation in England and Wales

Guro Huby*, Fiona M. Harris, Alison E. Powell, Tara Kielman, Aziz Sheikh, Sian Williams, Hilary Pinnock

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

This article draws on theories of social capital to understand ways in which the negotiation of professional boundaries among healthcare professionals relates to health services change. We compared reconfiguration of respiratory services in four primary care organisations (PCOs) in England and Wales. Service development was observed over 18 months during a period of market-based reforms. Serial interviews with key clinicians and managers from hospital trusts and PCOs followed progress as they collaborated around, negotiated and contested developments. We found that professionals work to protect and expand their claims to work territory. Remuneration and influence was a catalyst for development and was also necessary to establish professional boundaries that underpinned novel service arrangements. Conflict and contest was less of a threat to change than a lack of engagement in boundary work because this engagement produced relationships based on forming shifting professional allegiances across and along boundaries, and these relationships mediated the social capital needed to accomplish change. However, this process also (re)produced inequalities among professions and prevented some groups from participation in service change.

Original languageEnglish
Pages (from-to)400-415
Number of pages16
JournalSociology of Health & Illness
Volume36
Issue number3
DOIs
Publication statusPublished - Mar 2014

Keywords

  • GENERAL-PRACTITIONERS
  • CARE
  • MANAGEMENT

Fingerprint

Dive into the research topics of 'Beyond professional boundaries: relationships and resources in health services' modernisation in England and Wales'. Together they form a unique fingerprint.

Cite this