Background During a period of continuing changes in society and increasing availability of medical information, publication of patients’ views on experiences of health and illness have gained greater prominence. By contrast, studies of medical perspectives have tended to concentrate on reported discontent and implications for workforce planning while leaving broader insights and concerns under-investigated. Since the applied skills of highly trained and publicly funded clinicians are vital for safe and effective delivery of the nation’s health care, it seemed important to explore new ways to consider components of medical professionalism and to set these in current NHS contexts. Rationale and fieldwork Focussing attention on the individual perspectives of NHS doctors in order to hear and understand their experiences of work was central to development of this thesis. An interpretive epistemological approach to biographical narratives as told by a group of 12 doctors drawing on 25 years of NHS experience included use of Situational Analysis Mapping to support detailed analysis of their richly informative, first-hand accounts. As knowledgeable and reflective informants with stories from diverse clinical specialties and differing personal viewpoints, their narratives produced a range of views and observations shaped by their lived experiences as clinicians. Poetic representation of sociologically-informative narrative extracts provided an effective vehicle for engaging mixed audiences and has evoked emotionally resonant reactions from doctors. Findings Strong connections between individuals’ core principles and enacted responses were evident; doctors identified preferred working practices which they believed supportive of delivery of high quality health care. Key aspects of professionalism, including professional autonomy, self-regulation and application of clinical knowledge, were challenged by progressive introduction of new working processes and regulatory mechanisms. Increased recording of clinical and administrative data for performance monitoring and achievement of targets produced reactive strategies in individuals and teams while challenging their sense of professional position or developed medical identity. Poorly performing colleagues and difficult team interactions caused much disruption while blurred ethical boundaries exposed contestable decision-making and demonstrated the limited effectiveness of external regulatory monitoring. Conclusions This research indicates that contemporary NHS doctors may experience conflict between what is expected in managed medical practice and their interpretation of best professional performance. Better understanding of these fundamental relationships could constructively contribute to reconsideration of contemporary medical professionalism and assist with progressive workforce preparation for an effective future NHS.

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Veterinary Medicine does not have a history in the social sciences and is therefore a fascinating field of study. Despite the growth of education research in the veterinary schools, the social and relational aspects of veterinary training and practice are under-examined, and could have profound effects on the ability of students to make a successful transition into qualified work. This thesis explored the development of occupational identity in veterinary students and newly-qualified veterinary surgeons, using narrative interview techniques and organisational policy analysis. From interviewees’ stories, a clear distinction could be drawn between the majority, who were vocationally-motivated, and a smaller group who were drawn to a veterinary career by the high academic standards required. All identified several influences on their own professional identity development: role models, the need to perform as competent and confident, and presenting an approved personality type in order to gain access to the practical experience required during training. The predominant story arc is that of becoming increasingly ‘vetlike’ as they progress through the course. Animal welfare is a substantial silence in the organisational discourse of veterinary medicine. The discourse analysis revealed the overwhelming presentation of the elite academic nature of the profession, at the expense of any mention of animal care or welfare, or acknowledgement of vocational motivation. A compelling collective responsibility was also identifiable in terms of upholding a professional reputation and its high standards. A strong occupational history contributes to this, leading to a very bonded occupational group. The idea of veterinary medicine not being a nine-to-five job is expressed in policy and resonated very strongly with interview participants. However, there exists a very clear, organisationally-sanctioned, officially-approved attitude towards veterinary life and work, allowing very little deviation. This has the subsequent effect that tolerance of weakness, unhappiness, or complaint is low; so that members are forced to either internalise their unhappiness or leave the profession entirely. Veterinary medicine is perceived as a career with high job satisfaction and a positive public image. However, awareness is increasing of worryingly high levels of mental illness, stress, unhappiness and dissatisfaction with their work among the veterinary workforce. This thesis suggests that one factor that could underlie this is a mismatch between a new entrant’s ideas of what a vet is and does, and the reality of a working life in veterinary practice. From the conclusions presented in this thesis - in particular the finding that, as a profession, veterinary medicine strives to distance itself from an animal care or animal welfare focus - I suggest that it is the confused messages received as part of the process of socialisation during training that could connect to many of the problems facing the modern entrant to the veterinary profession. This research specifically focused on the development of occupational identity in veterinary students and newly-qualified veterinary surgeons in the UK and is the only current work to examine the processes, presentation and experiences of veterinary training in this comparative manner. As a relatively new, and very interdisciplinary, field of study, the capacity for future work in veterinary social sciences is considerable, with much to be learnt from allied fields as well as further explorations of just what makes veterinary medicine unique, and such a valuable source of social inquiry given the significance of pets and livestock to the lives of a nation of animal lovers. This is potentially a very rich field.

How can marginalised communities organise a project to yield significant social change? This thesis theorises the resources which enable such community organisation to work. Participation, empowerment and conscientisation are understood, not through a logic of quantity which creates linear dimensions, but through a logic of concrete qualities. A pragmatist approach is taken, to define our constructs in terms of the actions being undertaken by participants, within specific, qualitatively distinctive domains. Activity theory is used to theorise participation as a process of collective activity, which is supported by shared rules, a division of labour and shared goals, and which is challenged by divergences of interest. A community case study of the Sonagachi Project, a successful HIV prevention project run by sex workers in Kolkata (India), is used to investigate participation. The case study is based on interviews and group discussions with sex workers and Project workers (sex workers employed by the Project), and observation of the daily activities of the Project. Sex workers relate to the Project as a source of support in solving their individual problems, gaining new powers, but not acting as collectivity members. Project workers are constituted as collectivity members, whose action interlocks with that of their colleagues, through participating in the politicising discourse of the Project, which states that sex workers should be granted “workers’ rights”, and through learning the rules of participation in meetings and the hierarchical division of labour. To be allowed to operate, the Project has to carefully adjust to local power relations, with madams, political parties, and funding agencies, in collaborative-adversarial relationships. In conclusion, the scope of participation is defined as producing significant, yet circumscribed, local change. To intervene in a fractured community is a political process in which the provision of new resources is both necessary and potentially divisive.