Professional Control Issues between Medicine and Nursing in Primary Care

There are issues of professional control implicit in the policy moves towards a ‘primary care-led NHS’. As the primary care sector becomes the focus for NHS service developments, policy initiatives continue to be guided by this concept (NHS (Primary Care) Act 1997 and the more recent white paper, The New NHS — Modern and Dependable, 1997). Recent policies such as the introduction of OP commissioning groups, have put the GP at the centre of all primary care services and not just those traditionally attached to general practice. However the role of nursing, having been ignored in the past, is acknowledged in the white paper. For each new primary care group, there is to be a nurse representative on each board, although the actual significance of this needs to be carefully assessed. Such recent trends have increased the power and control doctors have over other health professionals, but, as independent practitioners, GPs may have little experience of working in a corporate way organisationally, and equally may have little experience of management and co-ordination. These additional roles will add to the already growing number of new responsibilities. A key issue is the relationship between doctors and other health professionals over ‘contested boundaries’. These can be discussed in terms both of actual tasks performed and of who has control over the tasks.