Skip to main content
SpringerLink
Log in

Beleaguered professionals: clinicians and institutional change in the NHS

  • Chapter
The Management of Expertise

Part of the book series: Management, Work and Organisations ((MWO))

Abstract

This chapter addresses the impact of institutional changes in the UK National Health Service on the expertise and professionalism of doctors. It not only surveys the scope and content of change, but also explores the implications for present understandings of the role of doctors in society. Medical practitioners are well worth studying in this context because they can be seen as the extreme end of the spectrum of professional and expert formation, the archetypal model of professional power and disciplinary knowledge. It follows, however, that while this group has much to tell us about the management of expertise in general, it is also one the most difficult groups to locate in a comparative study of expertise. Indeed there is a good case for arguing that their massively ramified professional formation is a unique historical phenomenon that defies ready comparison or generalisation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Abbott, A. (1988) The System of Professions: An essay on the division of expert labour ( Chicago and London: University of Chicago Press).

    Google Scholar 

  • Ashburner, L. (1993) ‘FHSAs: authorities in transition’, Research for Action Paper 8 ( Bristol: NHSTD ).

    Google Scholar 

  • Ashburner, L. and Cairncross, L. (1993) ‘Membership of the “newstyle” health authorities: continuity or change?’, Public Administration, vol. 71, no. 3, pp. 357–75.

    Article  Google Scholar 

  • Atkinson, P. and Delamont, S. (1990) ‘Professions and powerlessness: female marginality in the learned occupations’, Sociological Review, vol. 38 (Feb.), pp. 90–110.

    Article  Google Scholar 

  • Burns, T. (1981) ‘A Comparative Study of Administrative Structure and Organisational processes in Selected Areas of the NHS’, Research Report ( London: Social Science Research Council).

    Google Scholar 

  • Calnan, M. and Gabe, J. (1991) ‘Recent developments in General Practice’, in J. Gabe et al., The Sociology of the Health Service ( London: Routledge).

    Google Scholar 

  • Crompton, R. (1990) ‘Professions in the Current Context’, Work, Employment and Society, special issue, pp. 147–66.

    Google Scholar 

  • Davies, C. (1983) ‘Professionals in Bureaucracies: The Conflict Thesis Revisited’, in R. Dingwall and P. Lewis (eds), The Sociology of the Professions ( London: Macmillan ).

    Google Scholar 

  • Dawson, S. et al. (1993) ‘In or Out of Management? Dilemmas and Developments in public health medicine’, paper presented to the Professions in Management in Britain Conference, Stirling University.

    Google Scholar 

  • Day, P. and Klein, R. (1987) Accountabilities: Five public services ( London: Tavistock).

    Google Scholar 

  • Dopson, S. (1993) ‘Management: the one disease consultants did not think existed’, paper presented to the Professions and Management in Britain Conference, Stirling University.

    Google Scholar 

  • Elcock, H. (1978) ‘Regional government in action: the member of two RHAs’, Public Administration, vol. 56, pp. 379–97.

    Article  Google Scholar 

  • Elston, M. A. (1991) ‘The politics of professional power: medicine in a changing health service’, in J. Gabe, M. Calnan and M. Bury The Sociology of the Health Service ( London & New York: Routledge).

    Google Scholar 

  • Ferlie, E., Ashburner, L. and Fitzgerald, L. (1993) ‘Board Teams: Roles and Relationships’, Research for Action Paper 10 ( Bristol: NHSTD ).

    Google Scholar 

  • Ferlie, E., Fitzgerald, L. and Ashburner, L. (1992) ‘The Challenge of Purchasing’, Research for Action Paper 7 ( Bristol: NHSTD ).

    Google Scholar 

  • Field, M. G. (1988) ‘The Position of the Soviet physician: The Bureaucratic Professional’, The Millbank Quarterly, vol. 66, Suppl. 2, pp. 182–201.

    Article  Google Scholar 

  • Fitzgerald, L. (1993) ‘Management Development for Consultants: Formative Evaluation of the Doctors in Business Schools Programme. Final Report’, unpublished report, Trent RHA/Department of Health.

    Google Scholar 

  • Fitzgerald, L. (1994) ‘Moving Clinicians into Management: A Professional Challenge or Threat?’, Journal of Management in Medicine, vol. 8, no. 6.

    Google Scholar 

  • Fitzgerald, L., Ferlie, E. and Ashburner, L. (1993) ‘Leadership by Boards in Health-care’, Research for Action Paper 12 ( Bristol: NHSTD ).

    Google Scholar 

  • Freidson, E. (1970) Professional Dominance: The social structure of medical care ( New York: Atherton Press).

    Google Scholar 

  • Freidson, E. (1983) ‘The Theory of Professions: state of the art’, in R. Dingwall and P. Lewis (eds), The Sociology of the Professions: Lawyers, doctors and others ( Basingstoke: Macmillan ).

    Google Scholar 

  • Friedson, E. (1987) ‘The Future of the Professions’, Journal of Dental Education, vol. 53, pp. 140–144.

    Google Scholar 

  • Goode, W.J. (1960) ‘Community within a community: the professions’, American Sociological Review, vol. 22, no. 194.

    Google Scholar 

  • Griffiths Report (1983) Report of the NHS Management Inquiry, (D83) 38 ( London: HMSO ).

    Google Scholar 

  • Hafferty, Frederic (1988) ‘Theories at the crossroads: a discussion of evolving views on medicine as a profession’, The Millbank Quarterly, vol. 66, no. 2, pp. 202–225.

    Article  Google Scholar 

  • Hall, R. H. (1988) ‘Comment on the sociology of the professions’, Work and Occupations, vol. 15, (Aug.), pp. 273–5.

    Article  Google Scholar 

  • Halpern, S. A. (1992) ‘Dynamics of professional control: internal coalitions and cross-professional boundaries’, American Journal of Sociology, vol. 97, pp. 994–1021.

    Article  Google Scholar 

  • Harrison, Stephen (1988) Managing the National Health Service: Shifting the frontier? ( London: Chapman and Hall).

    Book  Google Scholar 

  • Harrison, S. and Schultz, R. I. (1989) ‘Clinical Autonomy in the UK and the USA: contrasts and convergence’, in G. Freddi and J. W. Bjorkman (eds), Controlling Medical Professionals ( London: Sage ).

    Google Scholar 

  • Harwood, A. and Boufford, I. J. (1993) Managing Clinical Services. A consensus statement of principles for effective clinical management, BAMM, BMA, IHSM, RCN ( London: Institute of Health Services Management).

    Google Scholar 

  • Haug, M. R. (1973) ‘Deprofessionalisation: an alternative hypothesis for the future’, Sociological Review Monograph, vol. 20, pp. 195–211.

    Article  Google Scholar 

  • Hetherington, R. H. (1982) ‘Quality assurance and organisational effectiveness in hospitals’, Health Services Management Research, vol. 17, no. 2.

    Google Scholar 

  • Larkin, G. (1988) Medical dominance-in Britain: image and historical reality, Millbank Quarterly vol. 6, suppl. 2, pp.117–31.

    Article  Google Scholar 

  • Lewis, J. (1987) ‘From public health to community medicine: the wider context’. in L. Willcocks and J. Harrow (eds), Rediscovering Public Service Management ( London: McGraw-Hill ).

    Google Scholar 

  • McKinlay, J. B (1988) ‘Introduction’, The Millbank Quarterly, vol. 66, no. 2.

    Google Scholar 

  • McKinlay, J. B. and Arches, J. (1985) ‘Toward the proletarianisation of physicians’, International Journal of Health Services, vol. 15, no. 2, pp. 161–95.

    Article  Google Scholar 

  • Murray, T. R., Dingwall, R. and Eekelar, J. (1983) ‘Professionals in bureaucracies’, in R. Dingwall and P. Lewis (eds), The Sociology of the Professions: Lawyers, Doctors and others ( Basingstoke: Macmillan ).

    Google Scholar 

  • Navarro, V. (1988) ‘Professional dominance or proletarianisation? Neither’, The Millbank Quarterly, vol. 66, no. 2, pp. 57–75.

    Article  Google Scholar 

  • NHS and Community Care Act (1991) (London: HMSO).

    Google Scholar 

  • Ovreteit, J. (1985) ‘Medical Dominance and the Development of Professional Autonomy in Physiotherapy’, Sociology of Health and Illness, vol. 7, pp. 76–93.

    Article  Google Scholar 

  • Parkin, F. (1979) Marxism and Class Theory ( New York: Columbia University Press).

    Google Scholar 

  • Parsons, T. (1951) The Social System ( London: Tavistock).

    Google Scholar 

  • Payer, L. (1988) Medicine and Culture: Varieties of treatment in the USA, England, West Germany and France ( New York: Henry Holt).

    Google Scholar 

  • Pettigrew, A., Ferlie, E. and McKee, L. (1992) Shaping Strategic Change: The case of the NHS ( London: Sage).

    Google Scholar 

  • Reuschemeyer, D. (1986) Power and the Division of Labour ( New York: Polity Press).

    Google Scholar 

  • Scott, W. R. (1985) ‘Conflicting levels of rationality: regulators, managers and professionals in the medical care sector’, Journal of Health Administration Education, vol. 3, no. 2, pt II, pp. 113–31.

    Google Scholar 

  • Stevens, R. (1966) Medical Practice in Modern England: The impact of specialisation and state medicine ( New Haven and London: Yale University Press).

    Google Scholar 

  • Stewart, Rosemary (n.d.) ‘Involving Doctors in General Management’, Templeton Series, Paper 5 (Bristol: NHSTA).

    Google Scholar 

  • Wolinsky, F. D. (1988) ‘The professional dominance perspective re-visited’, The Millbank Quarterly, vol. 66, no. 2, pp. 33–47.

    Article  Google Scholar 

Download references

Authors
  1. Lynn Ashburner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louise Fitzgerald
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Warwick Business School, UK

    Harry Scarbrough (Lecturer in Industrial Relations and Organizational Behaviour) (Lecturer in Industrial Relations and Organizational Behaviour)

Copyright information

© 1996 Harry Scarbrough

About this chapter

Cite this chapter

Ashburner, L., Fitzgerald, L. (1996). Beleaguered professionals: clinicians and institutional change in the NHS. In: Scarbrough, H. (eds) The Management of Expertise. Management, Work and Organisations. Palgrave, London. https://doi.org/10.1007/978-1-349-24394-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-349-24394-5_9

  • Publisher Name: Palgrave, London

  • Print ISBN: 978-0-333-56870-5

  • Online ISBN: 978-1-349-24394-5

Publish with us

Policies and ethics

Search

Navigation