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Wilson N1, Roberts L1, Pope C1, Crouch R1
1University of Southampton, Southampton, United Kingdom
Background: First contact physiotherapists in general practice, advanced practice physiotherapists in emergency care, and consultant physiotherapists across a range of healthcare specialties are just some of the roles now undertaken by UK physiotherapists in the 21st century. Arguably these 'noctors' - a colloquialism used to describe health professionals who are not doctors but who undertake practices previously only performed by medically-qualified professionals - are signals of physiotherapy's professional autonomy and social mobility - a far cry from the supervised massage practices of the professions' founders. While it is commonplace to view developments in professional roles as customary responses to rising demand for healthcare, financial pressures and shortages in the medical workforce, this perspective tends to overlook the significant contextualised professional agency implicated in the expansions of physiotherapy's jurisdiction.
Purpose: This paper aims to recover the historical context and processes leading to the construction of some of the profession's newest subjectivities. Through a critical genealogy of physiotherapy's professional project in the UK, some of the influential discourses effecting the transition from masseuse to 'noctor' are brought to the fore.
Methods: Data for this study were gathered from the Chartered Society of Physiotherapy archives, 19th and 20th century texts from British medical journals, and UK policy documents. We employed a discursive methodology, framed within a model of contextualised professional agency. Analysis was informed by Foucault's notion of social power - situated sets of relations between people, objects and events that constitute new subjectivities and professional practices.
Results: The findings of this study focus on four key moments within the profession's history, from the emergence of the Society of Trained Masseuses in London in the late 1800s amidst massage scandals, to the implementation of physiotherapist independent prescribing practices in contemporary UK healthcare. At each juncture, we expose the multiplicity of force relations with other actors and institutions, and the significant work done by the profession to claim new jurisdictions. We identify a template, formulated by interactions between professionals, institutions and health policy, from which novel professional subjectivities emerge.
Conclusion(s): Undertaking a critical genealogy of physiotherapy's professional project in the UK provides insight into the contingent nature of new role development and the individual and collective agency underpinning physiotherapy's jurisdictional expansion, thereby challenging the assumption that new roles are solely intuitive responses to workforce pressures.
Implications: The value of this research is twofold. First, it enriches our understanding of physiotherapy's present and past, and second, it offers an alternative template with which to shape the future of physiotherapy within the system of professions.
Keywords: Professionalisation, History, United Kingdom
Funding acknowledgements: No funding
Purpose: This paper aims to recover the historical context and processes leading to the construction of some of the profession's newest subjectivities. Through a critical genealogy of physiotherapy's professional project in the UK, some of the influential discourses effecting the transition from masseuse to 'noctor' are brought to the fore.
Methods: Data for this study were gathered from the Chartered Society of Physiotherapy archives, 19th and 20th century texts from British medical journals, and UK policy documents. We employed a discursive methodology, framed within a model of contextualised professional agency. Analysis was informed by Foucault's notion of social power - situated sets of relations between people, objects and events that constitute new subjectivities and professional practices.
Results: The findings of this study focus on four key moments within the profession's history, from the emergence of the Society of Trained Masseuses in London in the late 1800s amidst massage scandals, to the implementation of physiotherapist independent prescribing practices in contemporary UK healthcare. At each juncture, we expose the multiplicity of force relations with other actors and institutions, and the significant work done by the profession to claim new jurisdictions. We identify a template, formulated by interactions between professionals, institutions and health policy, from which novel professional subjectivities emerge.
Conclusion(s): Undertaking a critical genealogy of physiotherapy's professional project in the UK provides insight into the contingent nature of new role development and the individual and collective agency underpinning physiotherapy's jurisdictional expansion, thereby challenging the assumption that new roles are solely intuitive responses to workforce pressures.
Implications: The value of this research is twofold. First, it enriches our understanding of physiotherapy's present and past, and second, it offers an alternative template with which to shape the future of physiotherapy within the system of professions.
Keywords: Professionalisation, History, United Kingdom
Funding acknowledgements: No funding
Topic: Professional issues; Service delivery/emerging roles
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: The information is freely available in the public domain.
All authors, affiliations and abstracts have been published as submitted.
