Skill mix in Primary Care: a study of the interface between the general practitioner and other members of the Primary Health Care Team

The Medical Manpower Standing Advisory Committee made its first report, “Planning the Medical Workforce”, to the Secretary of State in December 1992; recommending that research should be undertaken to quantify the manpower effects of skill mix initiatives. These issues are being raised against a background of changing roles under the GP Contract, manpower shortages and boundary definitions and enhanced roles for nursing staff as well as shifts at the primary/secondary interface and by other initiatives such as the growth in day surgery and early discharge from hospital. Given the acknowledged complexity, this initial research has focused on the interface between the general practitioner (GP) and other members of the Primary Health Care Team (PHCT). Detailed data are needed on the work patterns of the doctors and nurses in the PHCT, on the extent of referral between members of the team, and on the acceptability and appropriateness of delegation from the GP to other members of the PHCT. Hence the broad aim of this enquiry; to propose ways of examining the constraints upon, and the opportunities for, spreading workload more effectively and efficiently amongst members of the PHCT. The objectives of this study were: • To document the current pattern of activities and interactions between the GP and other members of the PHCT. • To assess the potential for some of the GP’s activities to be performed by other members of staff in terms of the mix of skills required. • To examine the attitude of GPs towards delegation, of the practice managers and nurses to taking on other responsibilities, and of everyone’s attitude towards team management. • To document the outcomes for patients and their views of the different working arrangements of the PHCT. • To estimate the costs of delegation in practices of varying size and configuration in order to make a preliminary assessment of cost-effectiveness.GPs, PHCTs, skill mix, workload