Changing roles and identities in primary health care: exploring a culture of uncertainty

Abstract

This paper highlights a key area of analysis emerging from research undertaken in order to explore cultural differences between medicine and nursing, and implications for primary care. Concerns about the role of nursing in primary health care within the UK are of particular interest to the authors. A specific concern centres on the movement of health care work from one group of health workers to another, in particular from doctors to nurses. A number of studies show that work is moving from doctors to nurses and explore the policy drivers, notably the pressure to improve the cost-effectiveness of care. However, few studies reflect on how ideas, values and beliefs are being challenged, confirmed and used to justify new roles and identities. We are interested in exploring this latter aspect of the movement of health care work, and argue that changing roles and identities create a culture of uncertainty which has important implications for the future of primary health care nursing.

Domestic abuse and women's health: the challenge for primary care

“…Supervision and support for staff is crucial to ensure safe and effective practice within primary care and this may be achieved through the framework of clinical supervision (Butterworth, 1992) or personal development plans (Department of Health, 1997bHealth, , 1998a. Ensuring the safety and support of primary health care team members can be addressed through improved team working, a process which may also ensure that practice responses are co-ordinated and coherent (see for example, Jenkins-Clarke et al, 1998;Long, 1996;Wiles and Robison, 1994;Williams and Sibbald, 1999). There is also an important role for domestic abuse to be addressed by new forms of primary care service delivery, such as NHS Direct and NHS Walk-in Centres.…”

“…The development of good practice is underpinned by the need for improved education and training about domestic abuse for all primary health care professionals (Abbott and Williams, 1999;Frost, 1997;Kingston et al, 1995;Peckover, 1998). Local interagency domestic violence forums have an important role in providing and coordinating training (Hague et al, 1996).…”

GPs, nurses and pharmacists as prescribers in primary care: an exploration using the social identity approach / Hausärzte/-innen, Diplomierte Pflegefachpersonen und Apotheker/-innen als Arzneimittelverschreiber/-innen: eine Exploration mit dem Ansatz der Sozialen Identität

“…The uncertainty created by nurses' emerging innovative roles, between GPs and nurses as well as between different groups of nurses, has been described previously (Williams & Sibbald, 1999). The social identity of nurse prescribers was clearly distinct from their wider professional group, situated in between a non-prescribing nurse and a doctor.…”

OECD Health Working Papers

“…Kinley et al (2001) highlight the potential for problematic relationships between members of the multidisciplinary team when changes are seen to be implemented for negative reasons for example because of policy requirements, economic reasons, shortages in workforce or because there is work that doctors no longer want. Williams and Sibbald (1999) describe the sense of loss and insecurity felt when GPs and nurses roles changed.…”

“…In many instances, such as in the UK where primary care services are under the financial control of GPs, the doctor still has control over defining the division of labour, and the feeling that medical staff are having a say in defining new nursing roles may lead to resentment (Williams and Sibbald 1999;Charles-Jones et al 2003). In a British Medical Journal editorial Zwarenstein and Reeves (2000) highlighted poor working relationships between doctors and nurses and present some limited evidence to suggest that poor collaboration leads to poor patient outcome.…”