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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, Simon and Levenson, R (2017) Physician associates in primary health care in England: A challenge to professional boundaries? Social Science and Medicine, 181. pp. 9-16.

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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
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Drennan, VM
Gabe, J
Halter, M
de Lusignan, SimonS.Lusignan@surrey.ac.uk
Levenson, R
Date : 23 March 2017
Identification Number : 10.1016/j.socscimed.2017.03.045
Copyright Disclaimer : © 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/
Uncontrolled Keywords : England; Health professions; Physician associates; Physician assistants; Primary care; Professional boundaries
Depositing User : Jane Hindle
Date Deposited : 15 Sep 2017 07:49
Last Modified : 10 Jan 2018 14:13
URI: http://epubs.surrey.ac.uk/id/eprint/842254

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