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This thesis explores reactions to changing occupational roles and identities precipitated by a Business Process Re-engineering management change programme within a National Health Service setting. The thesis offers further understanding of the changing nature of professional roles and occupational identities within health care. Taking a qualitative approach, through the use of interviews and focus groups, the empirical core of the PhD examines professional employees' responses to changes in their own working practices. The main thrust of the argument is that work reorganisation that changes the role and scope of practice impacts on occupational identities. The empirical work demonstrates how the effects of change in working practice create a situation whereby there are clearly defined winners and losers within and between professions. This thesis links such a recognition with the multiplicity of interests and the complexities of professional occupational identities within health care. An added dimension is the extent to which disciplinary knowledge creates these professional roles and occupational identities. If health care professionalism is to be redefined there is a requirement for an agenda which addresses the issue of how knowledge and expertise are acquired.

The findings of KAP studies and health reports indicate that in spite of continuing efforts by developing countries like Malawi, to raise health awareness among their peoples, the majority of the people remain inadequately informed and are generally found to lack basic knowledge about most prevalent diseases. As a result most people are unable to participate fully in primary health care activities. Two parallel surveys were carried out: (i) on activities of providers of information; and (ii) on information-seeking behaviour of a sample of the public. A health knowledge test was conducted to a sample of the public in order to assess their levels of Aids and bilharzia awareness. On matching the findings from the two surveys the following deficiencies were identified. The major cause of problems was that information provision was fragmented. Conflicting messages were given by different agencies which appeared to compete with each other. Distribution and access to the available information was also found to cause problems. Lack of research-based knowledge among health information providers about information needs and information-seeking behaviour of the people they are planning services for compounds the problems of information provision. Potential solutions include coordinating all activities of health communication from top-to-bottom (i.e. from planning to implementation at the community level). Efforts towards strengthening extension services, consolidating and repackaging of information, and consolidating of health grey literature are argued to be appropriate. Promoting use and marketing of the available information among the rural populations is also argued to be appropriate.

The aim of this thesis was to observe appointment negotiations in general practice, and investigate patients' and receptionists' experiences of appointment making. Improving access to health care is a National Health Service priority. These priorities are manifest when patients' request an appointment to see their GP. This study was conducted in three general practices on Tyneside: a singlehanded practice; a three doctor practice; and a seven-doctor practice. Two methods were used, participant observation, consisting of observing and recording practice activities and observations with informal interviews, and long interviews with patients and professionals. Activity recordings and observations were conducted in waiting rooms, behind reception counters, and in other settings. There were 35 activity recordings and 34 periods of observation. Thirty-eight patients and 15 professionals were interviewed. Participants were selected by theoretical sampling. These included 12 short interviews with patients attending an 'open access'surgery. Six groups of patients (23) and 15 professionals were selected for long interview. These included patients who complained about appointment making or who complimented the receptionists. Transcripts of observations and interviews were analysed by theoretical coding and data display to identify concepts and categories of data. Several methods were used to enhance the research's quality. Outcomes from appointment negotiations are influenced by patient's illness behaviour, the process of negotiation, and appointment availability. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Receptionists also work outside 'official' practice rules to manage limited appointment availability. These strategies include 'fitting patients in, ' reserving appointments, referring to other professionals and using advocates to support their actions. Patients volunteer information to provide evidence that their complaint is appropriate, and employ strategies, such as assertiveness, and threats, to try and obtain appointments. Receptionists have a crucial role in managing patient access that remains unacknowledged by policy makers.