King's Business School, King's College, London, UK.
School of Healthcare, University of Leeds, Leeds, UK.
Sociol Health Illn. 2019 Nov;41(8):1667-1684. doi: 10.1111/1467-9566.12983. Epub 2019 Aug 12.
Adopting a critical realist perspective, this article examines the emergence of a relatively new non-professional healthcare role, the assistant practitioner (AP). The role is presented as a malleable construct cascading through and sensitive to structure-agency interaction at different levels of NHS England: the sector, organisation and department. At the core of the analysis is the permissiveness of structures established at the respective levels of the NHS, facilitating or restricting agency as the role progresses through the healthcare system. A permissive regulatory framework at the sector level is reflected in the different choices made by two case study NHS acute hospital trusts, in their engagement with the AP role. These different choices have consequences for how the AP impacts at the departmental level.
采用批判现实主义的观点，本文考察了一个相对较新的非专业医疗保健角色——助理医师（AP）的出现。该角色被呈现为一个可塑的结构，通过与英格兰国民保健制度（NHS）不同层次的结构-代理相互作用而形成，并对其敏感：部门、组织和部门。分析的核心是 NHS 各个层次上建立的结构的宽容性，这使得该角色在医疗保健系统中发展时，能够促进或限制代理的作用。部门层面上宽松的监管框架反映在两个案例研究 NHS 急性医院信托机构在参与 AP 角色时所做出的不同选择。这些不同的选择对 AP 在部门层面上的影响产生了后果。
