School of Health Sciences, University of Southampton, Highfield, Southampton, UK.
J Foot Ankle Res. 2010 Jan 5;3(1):1. doi: 10.1186/1757-1146-3-1.
The last decade has witnessed a rapid transformation in the role boundaries of the allied health professions, enabled through the creation of new roles and the expansion of existing, traditional roles. A strategy of health care 'modernisation' has encompassed calls for the redrawing of professional boundaries and identities, linked with demands for greater workforce flexibility. Several tasks and roles previously within the exclusive domain of medicine have been delegated to, or assumed by, allied health professionals, as the workforce is reshaped to meet the challenges posed by changing demographic, social and political contexts. The prescribing of medicines by non-medically qualified healthcare professionals, and in particular the podiatry profession, reflects these changes.
Using a range of key primary documentary sources derived from published material in the public domain and unpublished material in private possession, this paper traces the development of contemporary UK and Australasian podiatric prescribing, access, supply and administration of medicines. Documentary sources include material from legislative, health policy, regulatory and professional bodies (including both State and Federal sources in Australia).
Tracing a chronological, comparative, socio-historical account of the emergence and development of 'prescribing' in podiatry in both Australasia and the UK enables an analysis of the impact of health policy reforms on the use of, and access to, medicines by podiatrists. The advent of neo-liberal healthcare policies, coupled with demands for workforce flexibility and role transfer within a climate of demographic, economic and social change has enabled allied health professionals to undertake an expanding number of tasks involving the sale, supply, administration and prescription of medicines.
As a challenge to medical dominance, these changes, although driven by wider healthcare policy, have met with resistance. As anticipated in the theory of medical dominance, inter-professional jurisdictional disputes centred on the right to access, administer, supply and prescribe medicines act as obstacles to workforce change. Nevertheless, the broader policy agenda continues to ensure workforce redesign in which podiatry has assumed wider roles and responsibilities in prescribing.
过去十年见证了医疗保健相关专业角色边界的快速转变，这得益于新角色的创建和现有传统角色的扩展。医疗保健“现代化”战略涵盖了重新划定专业边界和身份的呼吁，这与对更大劳动力灵活性的需求相关联。以前属于医学专属领域的几个任务和角色已被委托给医疗保健相关专业人员或由其承担，因为劳动力正在重新塑造以应对不断变化的人口、社会和政治背景所带来的挑战。非医学资质的医疗保健专业人员开处方药，特别是足病学专业人员开处方药，反映了这些变化。
本文利用一系列主要的原始文献资源，这些资源来源于已公开的出版材料和私人持有的未公开材料，追溯了当代英国和澳大拉西亚足病学处方、准入、药品供应和管理的发展历程。文献资源包括立法、卫生政策、监管和专业机构（包括澳大利亚的州和联邦来源）的材料。
追溯在澳大拉西亚和英国足病学中“处方”出现和发展的时间顺序、比较性、社会历史记录，使我们能够分析卫生政策改革对足病医生使用和获得药物的影响。新自由主义医疗保健政策的出现，加上对劳动力灵活性和角色转移的需求，以及人口、经济和社会变革的背景，使医疗保健相关专业人员能够承担越来越多涉及销售、供应、管理和处方药物的任务。
作为对医学主导地位的挑战，这些变化虽然是由更广泛的医疗保健政策驱动的，但也遭到了抵制。正如医学主导地位理论所预期的那样，以准入、管理、供应和处方药物为核心的跨专业管辖权争端，成为劳动力变革的障碍。然而，更广泛的政策议程继续确保劳动力重新设计，其中足病学在处方方面承担了更广泛的角色和责任。
