title: Beyond professional boundaries: relationships and resources in health services' modernisation in England and Wales.
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.
authors.affiliation: School of Health in Social Science, University of Edinburgh and Faculty of Health and Social Studies, University College Østfold, Norway.
authors.forename: Guro
authors.initials: G
authors.lastname: Huby
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Harris
authors.forename: Alison E
authors.initials: AE
authors.lastname: Powell
authors.forename: Tara
authors.initials: T
authors.lastname: Kielman
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Sian
authors.initials: S
authors.lastname: Williams
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
mesh_terms: D004739:England; D006282:Health Personnel / Q000523:psychology*; D006295:Health Resources / Q000458:organization & administration*; D006298:Health Services Administration; D006801:Humans; D007400:Interprofessional Relations; D009936:Organizational Innovation; D011320:Primary Health Care; D036301:Qualitative Research; D012124:Respiratory Care Units / Q000458:organization & administration; D012138:Respiratory Therapy; D013222:State Medicine; D014852:Wales