The reforming of the UK National Health Service (NHS), in response to pressure on financial resources, has led to the reshaping of healthcare professionals' roles. Within
NHS hospitals, clinicians traditionally have held a dominant position in terms of decision making with regard to the use of resources and clinical autonomy. However, the changing environment now faced by hospital clinicians, in the form of increasing financial, legal and regulatory complexities is having an impact on their power base as managerial and accounting control becomes a key element in the changes advocated by
healthcare reformers. Some have argued that these changes challenge the power and autonomy of clinicians and their relationships with other healthcare professionals and
society; perhaps best exemplified by the increasing role of clinical pharmacists in prescribing decisions. In the past, pharmacy as a health care function has been termed a
marginal or quasi-profession due to its apparent inability to promote and control its existence. Traditional professional and jurisdictional boundaries militated against a closer working relationship between pharmacists and clinicians, contributing to this marginalisation.This thesis investigates the impact that NPM initiatives and increases in financial accountability have had on the pharmacy and the medical professions. It will be shown that, over the last 25 years or so, there have been significant developments in hospital pharmaceutical services which have served to erode the professional boundaries through the emergence of specialist pharmacy services and clinical pharmacists that
operate in the clinical setting. The findings demonstrate that, clinical pharmacists, whose specialism is to assist the clinicians in safe, economic and effective use of medicines by optimizing pharmaceutical factors, are increasingly being utilized and regarded as an essential function within the hospital setting. Indeed it has been suggested by both parties that as clinicians increasingly feel the pressure of financial
constraints that pharmacy's involvement in clinical decisions and prescribing practice should continue to increase.This research, therefore, illuminates the erosion of professional boundaries within healthcare as a result of NPM initiatives and increased financial accountability. In
particular it focuses upon the changing relationship between pharmacy and the medical profession. The baseline for this study is the period between the Conservatives government reign under the leadership of Margaret Thatcher to the end of New Labour's term in office. The empirical findings generate valuable information that helps to explain and aid our understanding of the professional relationships of clinical pharmacists and clinicians in the current drive towards the rationalisation of
prescribing and cost containment procedures. It further, shows how changes in financial accountability have served as a catalyst in the erosion of professional boundaries between the two professions
