Shifting discourses of professionalism: a case study of general practitioners in the United Kingdom

Abstract

This paper addresses shifting constructions of professional identity in the context of debates about reflexive modernisation and the changing role of professionals in the provision of primary healthcare. Data are drawn from interviews with 20 early-career general practitioners (GPs), who accounted for their orientations towards work in rather different ways from those typically reported in much primary care research. In particular, they reported high job satisfaction and success in achieving what they called 'nice work'. We argue that these GPs typify a shift in discourses of professionalism, characterised by respondents as the 'new general practice', which explicitly rejects many values attributed to 'traditional' general practice. Within the 'new general practice', professionalism has been de-coupled from some of the paradigmatic traits of traditional rhetorical accounts (such as vocation), and has significantly reframed others. Despite policy concerns that a retreat from 'vocational' professionalism will lead to reductions in service quality, we argue that this is not inevitable. The 'new general practice' resonates with the social values of reflexive modernisation, and has the potential to enable new, less paternalistic, forms of relationships with clients, although it remains to be seen whether this potential is realised in healthcare delivery.

Professional relations in sport healthcare: Workplace responses to organisational change

“…As Martin, Currie and Finn (2009) note, relatively few studies contextualise the discourses groups use to legitimate their jurisdictional claims within technological developments or policy change (exceptions include Lupton, 1997;Jones & Green, 2006). The value of such studies, however, is that they combine relatively abstract macro-level claims about professions with substantive micro-level changes in everyday practice.…”

“…Olympic sports have also largely depended on the services of voluntary team doctors (Green & Houlihan, 2005), and Carter (2009) argues that this reflects a tradition of civic obligation within the medical profession in Britain, indicative of the traditional coupling of vocationalism and professionalism in general practice (cf. Jones & Green, 2006). Continuing debate about whether BASM should be a doctor-only or multidisciplinary body (Reynolds & Tansey, 2009) is indicative of boundary blurring.…”

Experience of contractual change in UK general practice: a qualitative study of salaried GPs

“…[13][14][15] Before 2004, salaried GPs were reported as experiencing lower stress levels than their principal counterparts, 16 and were located in democratic, collaborative practices conducting highly satisfying and varied 'nice work'. 17 By contrast they perceived their GP principals as conducting the 'unrewarding' or 'burdensome' work. 17 The only post-2004 study to date that has sought to elicit the views of salaried GPs in relation to the recent changes reported a very different situation.…”

“…17 By contrast they perceived their GP principals as conducting the 'unrewarding' or 'burdensome' work. 17 The only post-2004 study to date that has sought to elicit the views of salaried GPs in relation to the recent changes reported a very different situation. 18 Salaried GPs were found to be conducting the unrewarding work by adopting 'the left-over or discarded jobs, mopping up the less complex and perhaps less professionally satisfying or challenging patients'.…”

“…While the views and experiences of GP principals and practice nurses have been reported elsewhere, 13,14,23 only two studies have focused on salaried GPs and reported almost diametrically opposing findings. 17 Furthermore, both studies also had limitations. The Jones and Green study sample 17 consisted primarily of locums and therefore is not representative of a typical salaried GP -one employed over a long(er)-term duration in a single practice.…”