The cry for professional intimacy: a UK study of changes in the working lives of expert practitioners in health and education during the early 21st century

Birkbeck, Fiona (2018) The cry for professional intimacy: a UK study of changes in the working lives of expert practitioners in health and education during the early 21st century. PhD thesis, University of Nottingham.

[img] PDF (minor corrections completed: to be approved) (Thesis - as examined) - Repository staff only - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Download (2MB)


This is a qualitative study investigating the impact of factors affecting the working lives of practitioners in Health and Education during the period 2006-2016. It was conducted in the context of the increasing evidence of low recruitment, low retention rates and a high incidence of stress amongst expert practitioners in these two public institutions. What emerges from the data is a cross-sector phenomenon identified here as a ‘cry for professional intimacy’, formed as these practitioners give voice to a strong desire to be allowed to refocus on the relational aspects of their work.

A review of contextual literature and related research pointed to an argument that pressures from the application of neo-liberal principles to the public sectors of Health and Education have created a new era of commodification and business style assessment of practice. At the national level, a loss of trust in our educators and doctors has been increased by the media moral panic over events such as the Shipman and Mid Stafford cases in Health, and in Education by the Climbié case and the condemnatory PISA report by McKinsey (2007).

Government statistics and surveys by professional bodies have documented the rising experience of stress amongst these practitioners, but there appeared to be a gap in research that focused on both the cross-service nature of this phenomenon and the voices of practitioners themselves. The aim of this research therefore was to address the absence of stakeholder voices and to capture data from senior practitioners. This is the first time that research has concurrently interrogated executive-level practitioners in Health and Education. Specific questions were: firstly, what changes are taking place in the working lives of expert practitioners in Health and Education? and, secondly, is there a shared pattern of experience between expert practitioners in both sectors?

Structuration (Giddens 1979; 2005; 2013), multiple-level analysis (Jepperson & Meyer 2011) and the concept of self-efficacy (Bandura 1982) formed the theoretical framework for this investigation.

This field study involved thirty-six semi-structured interviews of practising leaders with at least ten years of management experience in Health and Education. The sample included hospital consultants, nurse directors, general practitioner (GP) partners, head teachers, Advanced Skills Teachers (ASTs) and university course leaders. Interviews were conducted in thirty institutions, including National Health Service (NHS) hospitals, GP practices, state secondary schools and universities.

Data analysis of the thematic coding showed a highly significant link (chi square p>0.0001) between autonomy, relationality and a consequent perception of efficacy amongst these practitioners in both sectors.

The results of this field study therefore serve as a powerful indicator of the cross-sectoral nature of the dissonance of expert practitioners in Health and Education in the UK. It indicates an urgent need for further research into the link between autonomy and relatedness to the efficacy and retention of practitioners in these public services.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Winship, Gary
Townsend, Andrew
Keywords: Voices of senior practitioners in NHS /Education; Erosion of autonomy and relationality; Cross sector phenomenon
Subjects: R Medicine > R Medicine (General)
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > School of Education
Item ID: 49741
Depositing User: Birkbeck, Fiona
Date Deposited: 16 Jul 2018 04:40
Last Modified: 08 May 2020 08:03

Actions (Archive Staff Only)

Edit View Edit View