Animals and anomalies: an analysis of the UK veterinary profession and the relative lack of state reform

The sociology of professions literature would predict that the contemporary state would not allow groups to continue unregulated or unreformed. However, this is indeed the case with the UK veterinary profession, with legislation dating back to 1966. Using an interdisciplinary analysis of published literature and reports, this paper assesses whether wider social, political and ethical dynamics can better explain this intriguing anomaly. We conclude with critical implications for the sociology of the professions. Furthermore, we argue that continuing to ignore the veterinary profession, and animals more generally, in sociological research will result in an impoverished and partial understanding of contemporary healthcare and occupations

Dissenting from care.data: an analysis of opt-out forms

Background Care.data was a programme of work led by NHS England for the extraction of patient-identifiable and coded information from general practitioner GP records for secondary uses. This study analyses the forms (on the websites of GP practices) which enabled patients to opt out. Methods Theoretical sampling and summative content analysis were used to collect and analyse dissent forms used by patients to opt out from care.data. Domains included basic information about the programme, types of objections and personal details required for identification purposes. Results One hundred opt out forms were analysed. Fifty-four forms mentioned that this programme was run by NHS England. Eighty-one forms provided 2 types of objections to data sharing and 15 provided only one objection. Only 26 forms mentioned that direct care would not be affected and 32 that patients maintain their right to opt back in anytime. All but one of the opt out forms we reviewed requested the name of the person wishing to opt out. Ninety-four required a date of birth and 33 an NHS number. Eighty-two required an address, 42 a telephone number and 7 an email address. Conclusion Numbers of patients (not) opting out should be treated with caution because the variability of information provided and the varied options for dissent may have caused confusion among patients. To ensure that dissent is in accordance with individual preferences and moral values, we recommend that well-designed information material and standardised opt out forms be developed for such data sharing initiatives

E-Infrastructures and the divergent assetization of public health data: Expectations, uncertainties, and asymmetries

Normative, scientific and economic pledges to Electronic Health Record (EHR) data-driven research (for health and wealth) attempt to reconfigure public health data as an asset for realising multiple values across healthcare, research and finance. In this paper, we examine some of the expectations, frictions and uncertainties involved with the assetisation of de-identified NHS patient data by (primary care) research services in UK. We introduce the concept of 'asymmetric assetisation divergence' to study the various practices of configuring and using this data, both as a continuously generated resource to be extracted and as an asset to be circulated in the knowledge economy. As data assetisation and exploitations grow bigger and more diverse, the capitalisation of these datasets may constitute EHR data-driven research in healthcare as an attractive technoscientific activity, but one limited to those actors with specific sociotechnical resources in place to fully exploit them at the required scale

Migrant NHS nurses as ‘tolerated’ citizens in post-Brexit Britain

With this paper we present European Union (EU) and non-EU nurses’ lived experiences of feeling ‘unwelcomed’ and ‘unsettled’ in a heightened xenophobic environment, in the workplace and elsewhere, following the 2016 EU Referendum. Brexit has exposed long-standing structural inequalities which oppress and disempower the NHS migrant labour force. Migrant nurses, a highly mobile and skilled workforce, were feeling increasingly disenfranchised and insecure in their employment. Drawing on notions such as tolerated citizenship and the contested political boundaries of belonging, and taking a situated intersectionality approach, we examine everyday bordering practices in the UK where the cultivation of a hostile environment is becoming increasingly prevalent. We contribute to the debates on forms of othering in post-Brexit Britain and question the instrumentality of policy interventions, closely connected to the ‘dangerous politics of immigration control’, which have far-reaching implications for long-term settlement of migrant nurses and other healthcare migrant workers

First point of contact physiotherapy; a qualitative study

© 2020 The Authors Objectives: First point of contact physiotherapy (FPCP) provides patients direct access to a physiotherapist. Literature demonstrates efficacy of FPCP. Evidence has highlighted the need for cultural shifts from both patient and professional perspectives to optimise FPCP. This study explored stakeholder perceptions of patient awareness and understanding of FPCP to better inform FPCP implementation. Design, setting, participants: A qualitative methodology utilised semi-structured interviews and focus groups. Findings from a previous realist review were used to generate a priori topic guides. Participants included patients, physiotherapists, GPs, administration staff, and commissioners. A thematic analysis was undertaken. Results: Four themes emerged that are described: level of patient awareness of the FPCP role situated against the GP as first contact practitioner, patients attain an awareness of FPCP from a variety of sources, patient understanding of physiotherapy arises from several sources and is poorly aligned with the FPCP model, characteristics and behaviours of patients influence access to FPCP services. Patient awareness and understanding was poor. Patients tended to view the GP as the default first contact practitioner. Traditional advertising approaches appeared on the whole invisible to patients and there was a reliance on signposting to facilitate patient access. Conclusion: Findings from this study can inform implementation of FPCP. Several obstacles to the optimisation of FPCP were highlighted. Improved marketing of physiotherapy generally and FPCP specifically may increase patient awareness and understanding. However, it is likely further time will be required to bring about the cultural shift in public perception required to optimise the potential of FPCP

Implementing human factors in clinical practice

OBJECTIVES: To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. METHODS: Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. RESULTS: The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. CONCLUSIONS: In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice

Austerity on the frontline- a preliminary study of physiotherapists working in the National Health Service in the UK

BackgroundOrganisational reform has been commonplace in the response to global socio-economic changes. Rising managerialism, consumerism and marketisation has accelerated reforms; providing challenges for the healthcare professions. The latest socio-economic challenge, austerity, and its professional implications have scarcely been researched. This study aims to explore the lived reality of austerity as experienced by physiotherapists working on the frontline of the National Health Service (NHS) in the UK. MethodsEthical approval was granted by the University of Nottingham; the study was advertised via the Chartered Society of Physiotherapy online network. Two participants took part; semi-structured interviews were completed, audio record and transcribed. Data was analysed using thematic analysis. FindingsThree themes arose from the data: fulfilling professional responsibilities, changing organisational landscape and the professional reality of rationalising and accommodating austerity. The clinical implications of austerity included increased length of hospital stay, insufficient community services, constrained resources and understaffing. Participants demonstrated attempts to preserve their professional status and services through restratification throughout the intra-professional hierarchy, changing division of labour and re-professionalisation. ConclusionsDespite claims that austerity is coming to an end, it remained a reality for these clinicians in the NHS. Physiotherapists in this study used similar methods to preserve practice when faced with exogenous constraints as seen in medicine, such as re-professionalisation and restratification. However, this attempt to defend professionalism by a non-medical healthcare profession was met with both successes and losses and has implications for the wider healthcare profession ecology, identifying an area for future research

The challenge of inclusive coproduction: the importance of situated rituals and emotional inclusivity in the coproduction of health research projects

Previous studies highlight that coproduced research initiatives are influenced by how individuals interact together, and that group inclusivity amongst diverse members is crucial. However, it not fully understood how inclusivity is sustained over time, particularly through routine encounters. Our study examines how coproduction occurs through routine and ritualistic patterns of everyday practices which have the potential to facilitate sustainable and inclusive research initiatives. Using ethnographic data with four applied health research projects, we explored how everyday rituals generate and sustain inclusivity. Informed by interactional ritual change theory, we identify two types of interlinked inclusivity: relational, individuals routinely engaging together, and emotional, the feeling of being included. The process of producing and maintaining both types requires ongoing reflexivity from members. Groups with sustained inclusivity build interpersonal momentum through situated practices that enable them to mitigate external pressures and internal disagreements. Where groups experience a breakdown in inclusivity, they also experience a loss of momentum that makes them vulnerable to disintegration and collapse. Building and sustaining inclusivity are worked out through everyday interactions and operate as a feedback loop that sustains the cohesiveness of the network and supports coproduction of knowledge

A technical solution to a professional problem: The risk management functions of prognosticators in the context of prognostication post-cardiac arrest

The risk management functions of prognosticators in the context of prognostication post-cardiac arrest. Cardiac arrest (CA) is a major cause of mortality and morbidity globally. Two-thirds of deaths among patients admitted to intensive care units following out-of-hospital CA are due to neurological injury, with most as a consequence of withdrawing life-sustaining treatment, following prognostication of unfavorable neurological outcome. Given the ramifications of prognosis for patient outcome, post-cardiac arrest (P-CA) guidelines stress the importance of minimizing the risk of falsely pessimistic predictions. Although prognosticator use is advocated to this end, % accurate prognosticators remain elusive, therefore prognostication P-CA remains pervaded by uncertainty and risk. Bioethical discourse notwithstanding, when located within a wider socio-cultural context, prognostication can be seen to present risk and uncertainty challenges of a professional nature. Such challenges do not, however, subvert the medical profession's moral and ethical prognostication obligation. We interpret prognosticator use as an attempt to manage professional risk presented by prognostication P-CA and demonstrate how through performing "risk work," prognosticators serve professional functions, mediating tension between the professional duty to prognosticate, and risk presented. We draw on sociological analyses of risk and uncertainty, and the professions to explicate these (hitherto less enunciated) professional risk management functions of prognosticators. Accordingly, the use of prognosticators is conceived of as a professional response-a technical/scientific solution to the problem of professional risk, inherent within the P-CA prognostication process