Changing skill mix in the primary care workforce: a comparison across nine European countries and the patient experience

Abstract

workforce patterns. Taken together the contributions in this workshop identify conditions and policy levers of an integrated people-centred primary care workforce on micro-, meso-and macro-levels of governance, spanning from health systems reform to leadership development and involvement of communities and patients. Conclusions The workshop adds value by revealing gaps in health policy and by creating a more detailed picture of the primary care workforce and the opportunities for innovation. The collection of papers highlights the benefits of comparative health workforce research and stimulates policy learning across countries. Key messages: Skill mix changes and workforce development are policy levers for strengthening primary care. Health workforce innovation needs to be supported by primary care policy and system reform. Innovating skill mix to strengthen primary care in high-and middle-income countries Irene Ariadne Glinos IA Glinos European Observatory, Brussels, Belgium Contact: igl@obs.euro.who.int Background Skill mix innovation is an integral part of primary and chronic care reforms. Countries pursue skill mix strategies to improve service delivery, adapt to changing patient needs and increase efficiency. This presentation compares strategies from 16 high-and middle-income countries focusing on innovation pathways , explanatory factors and outcomes. Methods and the UK, compiled by local experts following a common template. Results Broad skill mix themes emerge: optimising skills by creating new professional groups or giving new skills and tasks to existing ones; facilitating team work and group practice; developing home care solutions; and adapting education and training. While new skill mixes provide solutions to service delivery, innovation can also bring fragmentation with disease-specific or health professional-specific measures, few links to wider systems, persistent silos, and uneven roll-out. Measures to equip patients and communities with new skills and tools appear rare. Factors that enable/hinder innovation include pay mechanisms, regulation, professional positions, and perceived need for change. Skill mix reforms show promising results, e.g. in improving access, though often partial. Systematic reporting is limited and long-term impact of changing attitudes is hard to measure. Conclusions Strengthening primary and chronic care reforms via skill mix involves building on skill mix innovations (task allocation, professions, teams, sectors and instruments); closing skill gaps (patients, informal carers); and choosing adequate reform strategies (top-down, bottom-up, piecemeal, system-wide, task dump). Key messages: Skill mix innovation can strengthen primary and chronic care reforms. Diversity in innovation design, drivers, scope and govern-ance allows mutual learning. Background Changing demography and patient demands challenge the sustainability of traditional systems of care (workforce capacity/ financial constraints). Many countries are responding by using the wider healthcare team to deliver care. In addition, newer ways of managing disease result in reduced hospital stays and in some cases patients are managed completely in primary care. The work reported here is part of the MUNROS programme, which describes the impact on practice, outcomes and costs of new roles for health professionals to inform future workforce planning. Methods Surveys were administered to healthcare professionals, health-care managers, and patients in Czech Turkey, along pathways for breast cancer, heart disease and type 2 diabetes. The surveys explored which professionals were involved in the delivery of care, the patients' experiences of that care and integration of care. A subset of patients also completed a survey about their preferences. Results In all countries a wide range of different healthcare professionals are involved in care provision with a large overlap of roles and responsibilities. Care has shifted more to primary care in some countries than others, and involvement of community-based staff varies by country and condition. Patients have high overall satisfaction, but there was a general preference for follow-up care to be provided by a specialist doctor. A specialist nurse was preferred over a general doctor/GP. Conclusions Extent of skill mix in the healthcare team varies by condition and country. There is a suggestion of status quo bias in the findings, for example patients who have not experienced care of a specialised nurse do not value it so highly.