Allied Health Professionals’ Roles and Boundaries in the “New” NHS

Changes in the way health care services are delivered in England have affected the roles and boundaries of healthcare professionals. The agendas of skill mix and inter-disciplinary team work have been facilitated by the migration of services into primary care. There is a growing body of research addressing the effect of healthcare organisation and delivery on the roles and boundaries of doctors and nurses. Very little research has focused on the third largest section of the professional healthcare workforce, allied health professionals. This study investigated the roles and boundaries of allied health professionals working in primary and secondary care contexts.

An ethnographic extended case based methodology was adopted. Two case studies were taken from a secondary care organisation, and two from a primary care organisation. Cases were identified in discussion with professional leads from the two organisations. Within the cases both purposeful and convenience sampling approaches were applied. Data were generated through semi-structured interviews, field work and non-participant observations. Analysis consisted of a broadly thematic approach; the emergent themes were presented within the case reports as an interpretive poly-narrative. Structuration theory provided a framework on which to develop a cross case analysis and frame the interpretations overall.

The emergent themes highlighted a number of important aspects related to professional roles and boundaries. The primary element shaping the roles and boundaries of allied health professionals was the complexity of the patient. The findings indicated a positive relationship between transparent and structured care and patient centred practice and team work. Finally and of significance was a neglect of rehabilitation within both primary and secondary care.

In order to promote inter-professional team work and patient centred practice there needs to be clarity of patient need and focus of service provision. The neglect of rehabilitation will have far reaching implications for the future.