The changing nature of disease and health care delivery provides an opportunity to restructure health care roles to meet future needs.
For example, for the increasing number of people with long-term or complex multiple conditions new specialist nurses could be needed to support community workers and health co-ordinators to integrate care across conditions and between health and social care (1). Prevention could also play a more prominent role, with lifestyle trainers and dieticians working with people in the community. With appropriate training and assessments of their appropriateness, new technologies and remote monitoring could be used.
The advent of physician assistants and advanced practitioner roles in physiotherapy, nursing and surgery are enabling staff to diagnose patients and prescribe treatments; plans are under way to extend these prescribing powers to podiatrists and physiotherapists (2).
Within hospitals, evidence suggests that hospital generalists, such as geriatricians, can provide high-quality care with shorter lengths of stay (3).
In general practice, nurse practitioners can deal with common conditions while delivering good quality of care (4,5), and pharmacists can help patients to manage medicine use (6). Shifting routine care to other professionals could enable GPs to focus on co-ordinating care for people with chronic or complex conditions.
What are the barriers to developing new roles and responsibilities?
Professional groups may view such attempts as devaluing their role or seeking to make cost savings rather than improve patient care.
Regulatory barriers limit how health care can be delivered and prevent the reassignment of routine medical tasks from clinicians to nurses and other health care staff.
Restructuring the delivery of health and social care could enable the system to be more patient-centred and could also prove more cost-effective; however, the scale of any efficiency savings should not be overstated.
- CSC Leading Edge Forum (2010). Report. The Future of Healthcare: It’s Health, Then Care
- Department of Health (2012). Press release. Prescribing Powers Proposed for Physiotherapists and Podiatrists
- White HL, Glazier RH (2011). Journal article. Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures. BioMedCentral Medicine
- Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B (2005). Research paper. Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews.
- Buchan J, Calman L (2005). Report. Skill-Mix and Policy Change in the Health Workforce: Nurses in advanced roles Organisation for Economic Co-operation and Development (OECD)
- Deloitte Centre for Health Solutions (2012). Report. Primary Care: Today and Tomorrow - improving general practice by working differently