Challenging the physiotherapy-medical boundary through NHS workforce modernisation policy: a Foucauldian-informed interpretive discursive account.

Abstract

Skill-mix change and task shifting among the healthcare workforce has become a key mechanism for the continued provision of effective public healthcare within funding constraints. However, decoupling the healthcare professions from their traditional professional work tasks is not straightforward. Previous research has shown that in some contexts jurisdictional boundaries remain resolute.

This thesis uses two case studies to explore the mechanism and effect of challenge to the physiotherapy-medical professional boundary, precipitated by policy to modernise the English National Health Service workforce. The first examines the socio-political events which accompanied the publication of a national clinical guideline that proposed a reconfiguration of healthcare professionals managing people with non-specific low back pain. The second investigates the practice of physiotherapist non-medical prescribing in a musculoskeletal outpatient service in a single NHS Trust in England. The methodology adopted is interpretive policy analysis, informed by Foucault’s writings about power/knowledge and governmentality.

Through the identification and analysis of policy-related symbolic languages, objects and acts holding meaning for the communities studied, and examination of the system of relations between them, the discursive and extra-discursive constituting and shaping the physiotherapy-medical boundary are revealed. A ‘grid of intelligibility’ is employed as a framework to discern the circuits of power and the technologies governing physiotherapy practice. ‘Medical professionalism’ – the pre-eminence of specialist physicians in this field of healthcare – emerged as a dominant discursive formation and the case studies show the significant professional and institutional work required to maintain this.

The findings of this thesis suggest that despite the strong policy rhetoric of workforce modernisation, medical professionalism at the physiotherapy-medical boundary continues to thwart jurisdictional change. The historically contingent discourses at the heart of this power struggle mean that both meso-level policies and local-level practice change, directed to workforce reconfiguration, have only limited impact.

More information

Identifiers

ORCID for Lisa Roberts: orcid.org/0000-0003-2662-6696

ORCID for Catherine Pope: orcid.org/0000-0002-8935-6702

Catalogue record

Export record