Physician associates in primary health care in England : A challenge to professional boundaries? / Drennan, Vari; Gabe, Jonathan; Halter, Mary; de Lusignan, Simon; Levenson, Ros.

In: Social Science & Medicine, Vol. 181, 05.2017, p. 9–16.

Research output: Contribution to journalArticle

Published

Standard

Physician associates in primary health care in England : A challenge to professional boundaries? / Drennan, Vari; Gabe, Jonathan; Halter, Mary; de Lusignan, Simon; Levenson, Ros.

In: Social Science & Medicine, Vol. 181, 05.2017, p. 9–16.

Research output: Contribution to journalArticle

Harvard

Drennan, V, Gabe, J, Halter, M, de Lusignan, S & Levenson, R 2017, 'Physician associates in primary health care in England: A challenge to professional boundaries?', Social Science & Medicine, vol. 181, pp. 9–16. https://doi.org/10.1016/j.socscimed.2017.03.045

APA

Drennan, V., Gabe, J., Halter, M., de Lusignan, S., & Levenson, R. (2017). Physician associates in primary health care in England: A challenge to professional boundaries? Social Science & Medicine, 181, 9–16. https://doi.org/10.1016/j.socscimed.2017.03.045

Vancouver

Author

Drennan, Vari ; Gabe, Jonathan ; Halter, Mary ; de Lusignan, Simon ; Levenson, Ros. / Physician associates in primary health care in England : A challenge to professional boundaries?. In: Social Science & Medicine. 2017 ; Vol. 181. pp. 9–16.

BibTeX

@article{4d9198afb59441b4b90f3f664d47debe,
title = "Physician associates in primary health care in England: A challenge to professional boundaries?",
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 observations 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.",
keywords = "England, Health professions, Physician associates, Physician assistants, primary care, professional boundaries",
author = "Vari Drennan and Jonathan Gabe and Mary Halter and {de Lusignan}, Simon and Ros Levenson",
note = "Jonathan Gabe is Professor of sociology at Royal Holloway, University of London",
year = "2017",
month = "5",
doi = "10.1016/j.socscimed.2017.03.045",
language = "English",
volume = "181",
pages = "9–16",
journal = "Social Science & Medicine",
issn = "0277-9536",
publisher = "Elsevier Limited",

}

RIS

TY - JOUR

T1 - Physician associates in primary health care in England

T2 - A challenge to professional boundaries?

AU - Drennan, Vari

AU - Gabe, Jonathan

AU - Halter, Mary

AU - de Lusignan, Simon

AU - Levenson, Ros

N1 - Jonathan Gabe is Professor of sociology at Royal Holloway, University of London

PY - 2017/5

Y1 - 2017/5

N2 - 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 observations 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.

AB - 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 observations 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.

KW - England

KW - Health professions

KW - Physician associates

KW - Physician assistants

KW - primary care

KW - professional boundaries

U2 - 10.1016/j.socscimed.2017.03.045

DO - 10.1016/j.socscimed.2017.03.045

M3 - Article

VL - 181

SP - 9

EP - 16

JO - Social Science & Medicine

JF - Social Science & Medicine

SN - 0277-9536

ER -