The development of the new assistant practitioner role in the English National Health Service: a critical realist perspective

Abstract

Adopting a critical realist perspective, this article examines the emergence of a relatively new non‐professional healthcare role, the assistant practitioner (AP). The role is presented as a malleable construct cascading through and sensitive to structure–agency interaction at different levels of NHS England: the sector, organisation and department. At the core of the analysis is the permissiveness of structures established at the respective levels of the NHS, facilitating or restricting agency as the role progresses through the healthcare system. A permissive regulatory framework at the sector level is reflected in the different choices made by two case study NHS acute hospital trusts, in their engagement with the AP role. These different choices have consequences for how the AP impacts at the departmental level.

Institutional support for new work roles: The case of care coordinators in the United States and England

“…For example, Kessler and colleagues (2015) studied task reallocation from nurses to nursing assistants in England and found that joint working occurred where nurses supported a ‘specialist‐discard’ logic — aiming to enhance their professional status by transferring lower‐status tasks like washing patients to nursing assistants — instead of a more traditional ‘hoarding’ logic — where nurses claimed control over all tasks, resisting collaboration with nursing assistants. Over time, English nurses’ gradual turn to a specialist‐discard logic facilitated the growth of an extensive nursing assistant workforce and alternative nursing roles like assistant practitioners (Kessler & Spilsbury, 2019). Other studies have highlighted the increasingly active role of managerial supports like career structures (Bach et al., 2008).…”

Constituting link working through choice and care: An ethnographic account of front‐line social prescribing

“…Such findings resonate with the experiences of other front‐line health‐care workers, whose roles were shaped in nuanced ways by local contexts (Gale et al., 2018 ). For assistant physicians in the UK, routines became a balance between individual agency and structural permissiveness, whilst national policy also played an important part (Kessler & Spilsbury, 2019 ). To date, the impact of wider policy evolution on the nature of link working does not appear to have been explored in detail.…”

Professional boundary struggles in the context of healthcare change: the relational and symbolic constitution of nursing ethos in the space of possible professionalisation

“…Professional jurisdictions and boundaries are critical factors in the configuration of health care. Accordingly, they are important for the organisation of care and a complex aspect of healthcare planning and management (Abbott, 1988, Currie et al ., 2010, Huby et al ., 2014, Jones et al ., 2019, Kessler and Spilsbury, 2019, Nancarrow and Borthwick, 2005). Moreover, as the paper will show, professional boundaries influence day‐to‐day professional practice, collaboration and care delivery (Cramer et al ., 2018, McMurray, 2011, Salhani and Coulter, 2009).…”

“…Changes particularly involve the construction of new professional categories and flexible work roles to cater for patient‐related needs in healthcare organisations. Kessler and Spilsbury (2019) suggest that the development of new work roles is among the most challenging types of healthcare change. However, while professional work and roles, opportunities for professionalisation as well as professional boundaries are under development due to transformations in the professional environment, this development is concurrently curtailed by the continuous struggle for upholding institutionalised professional boundaries (Currie et al ., 2012, McMurray, 2011).…”

“…I wish to forward a focus on organisational, institutional and political boundary enterprises as well as responses to them. Understanding such mechanisms is key for developing a solid foundation for policy and management in health care (Kessler and Spilsbury, 2019).…”