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Physician associates in primary health care in England: A challenge to professional boundaries?

Drennan, VM; Gabe, J; Halter, M; de Lusignan, S; Levenson, R (2017) Physician associates in primary health care in England: A challenge to professional boundaries? Soc Sci Med, 181. pp. 9-16. ISSN 1873-5347 https://doi.org/10.1016/j.socscimed.2017.03.045
SGUL Authors: Drennan, Vari MacDougal

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Abstract

Like other health care systems, the National Health Service (NHS) in England has looked to new staffing configurations faced with medical staff shortages and rising costs. One solution has been to employ physician associates (PAs). PAs are trained in the medical model to assess, diagnose and commence treatment under the supervision of a physician. This paper explores the perceived effects on professional boundaries and relationships of introducing this completely new professional group. It draws on data from a study, completed in 2014, which examined the contribution of PAs working in general practice. Data were gathered at macro, meso and micro levels of the health care system. At the macro and meso level data were from policy documents, interviews with civil servants, senior members of national medical and nursing organisations, as well as regional level NHS managers (n = 25). At the micro level data came from interviews with General Practitioners, nurse practitioners and practice staff (n = 30) as well as observation of clinical and professional meetings. Analysis was both inductive and also framed by the existing theories of a dynamic system of professions. It is argued that professional boundaries become malleable and subject to negotiation at the micro level of service delivery. Stratification within professional groups created differing responses between those working at macro, meso and micro levels of the system; from acceptance to hostility in the face of a new and potentially competing, occupational group. Overarching this state agency was the requirement to underpin legislatively the shifts in jurisdictional boundaries, such as prescribing required for vertical substitution for some of the work of doctors.

Item Type: Article
Additional Information: © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: England, Health professions, Physician assistants, Physician associates, Primary care, Professional boundaries, England, Humans, Nurse Practitioners, Physician Assistants, Primary Health Care, Professional Role, Professionalism, Qualitative Research, State Medicine, Humans, Professional Role, Qualitative Research, Physician Assistants, Nurse Practitioners, State Medicine, Primary Health Care, England, Professionalism, England, Health professions, Physician associates, Physician assistants, Primary care, Professional boundaries, England, Health professions, Physician assistants, Physician associates, Primary care, Professional boundaries, 1117 Public Health And Health Services, 1601 Anthropology, 1608 Sociology, Public Health
Journal or Publication Title: Soc Sci Med
ISSN: 1873-5347
Language: eng
Dates:
DateEvent
May 2017Published
23 March 2017Published Online
22 March 2017Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
09/1801/1066National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
PubMed ID: 28364578
Web of Science ID: WOS:000401211000002
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110382
Publisher's version: https://doi.org/10.1016/j.socscimed.2017.03.045

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