Reconfiguring or Reproducing the Intra- Professional Boundaries of Expertise? Generalist and Specialist Knowledge in the Modernization of Genetics Provision in England

Efforts to ‘modernize’ public services in England have involved attempts to reconfigure the distribution of knowledge and responsibility between professions and subprofessions. Here, the authors take the example of the ‘mainstreaming’ of clinical genetics in the National Health Service to examine the course of an attempt to increase the genetics knowledge of general practitioners (family physicians). The example illustrates the limits to attempts to promote knowledge sharing, as the threat perceived by clinical geneticists saw them use their institutionalized power base to ensure that the redistribution was a conservative one, which reproduced, rather than reconfiguring, boundaries of knowledge and jurisdiction.