The loosening link between skills and professions : the case of UK physiotherapists

This paper examines the link between skill and professionalization. Entry to the traditional, self-governing professions rested on the acquisition of Level 4 skills though higher education degrees. In this respect, the recently revised UK Standard Occupational Classification (SOC) reclassified upwards some occupations as Professionals (Major Group 2) that were previously classified as Associate Professions (Major Group 3) because these occupations now require these degrees for occupational entry. The largest group of reclassified occupations are the Health Associate Professionals. This reclassification is the outcome of ‘professionalization projects’ by these occupations as they have deliberately shifted their education and training from the workplace into universities in order to boost their status. However reclassification makes no empirical account of actual skill use in the workplace by these new professions. Moreover whilst the new Health Professions are held up as emblematic of the new wave of professionalism, current research focuses on what is termed ‘institution work’ – i.e. the process of acquiring professional status – rather than the ‘task work’ of these occupations. This paper seeks to address these gaps in understanding. Its analysis envelops the development, supply, demand and deployment of skills amongst a reclassified occupation in the UK’s National Health Service – physiotherapists. The research provides an opportunity to examine whether this occupational reclassification is a product of genuine upskilling. Primary empirical data is drawn from interviews with a purposive sample of relevant stakeholders in this new profession: experienced physiotherapists; physiotherapy students, university lecturers involved in physiotherapy training, physiotherapy employers; occupational representative bodies; the Health Professions Council, the government’s Health Department; and. In addition, analysis was undertaken of NHS and government documentary material. The findings suggest a mixed outcome in terms of workplace skill use with newly fragmented work and new divisions of labour within physiotherapy. Despite Level 4 skills as an occupational entry requirement, only a few physiotherapists have experienced upskilled task work, more others are undergoing work genericization, leading to deskilling. Moreover some physiotherapy work is now undertaken by workers with sub-degree level skills. In addition, control of the occupation’s education and training has passed from the occupation’s representative body to the state. These developments have significant outcomes for physiotherapy as an occupation and, importantly, as a profession. It suggests a loosening link between the skills required for entry to the occupation and which result in the reclassified status, and those skills required to do physiotherapy work, which, for most workers in the occupation, fall short of those normally associated with professional labour. Moreover what is happening to physiotherapy is being replicated in the other reclassified Associate Health Professions in the NHS. Conceptually, the findings suggest that these new professions represent a hybridized professionalism, obtaining the semblance but not the substance of traditional professionalism – which is ironic given the long struggle for professional recognition for these female-dominated occupations. The findings also suggest that the analysis of skill within the methodology underpinning the SOC needs to be revisited