Non-medical practitioner roles in the UK: who, where, and what factors influence their development?

Abstract

Background: traditional health workforce roles are changing, with existing roles being extended and advanced, while new roles are being created, often undertaking duties previously completed by doctors, sometimes referred to as non-medical practitioners (NMPs). Aim: to investigate which NMP roles exist within the UK, mapping distribution, and explore factors influencing their development and recruitment. Methods: two descriptive, exploratory, online self-completed semi-structured questionnaires were used. One was sent to all NHS acute healthcare providers (n=156) and private/independent healthcare providers in England (n=90). A separate questionnaire collected data, using convenience and snowballing approaches, from NMPs across the UK. Quantitative data were analysed using descriptive and frequency statistics. Qualitative data derived from open questions and comments were analysed using content and thematic analysis. Results: healthcare organisations in England returned 23/246 useable questionnaires; 115 NMPs returned responses, 19 did not meet the criteria, leaving 96 useable responses. Conclusion: seven NMP roles were identified, throughout the UK, with regional variation. Several factors influence the development and recruitment of NMP roles in England such as service delivery and national policies. Inconsistencies were noted in Agenda for Change pay banding. Many practitioners undertook NMP roles to progress their career clinically.

The current state of the surgical care team in the United Kingdom: Shall we ‘do a time out’?

“…National policies and guidance have driven changes in the perioperative workforce and account for the diverse roles seen today in the make-up of the surgical teams (Abraham 2020, Abraham et al 2019). In the United Kingdom, several titles and roles for extended surgical team practitioners can be found (see Figure 1), arguably confusing patients, employers and clinicians and creating uncertainty among practitioners themselves.…”

“…However, implementing this service requires financial resources and support from NHS employers (RCSEng 2016a). Despite many reporting the benefits of the surgical care team (also themed ‘extended surgical team’), analysing the efficacy of extended and advanced roles can be an extraordinarily complex task, especially as in their inception are unique service needs, perioperative workforce planning strategies and national developments (Abraham et al 2019, Williams 2016). As Mathews (2017, p.266) has put very clearly, ‘the heterogeneity of the roles and the spectrum of needs within departments across the country, means that one size does not fit all’.…”

“…Nevertheless, the authors feel that such a comparative analysis (between roles and between contexts) can yield valuable insights to students and those onboarding perioperative practice, as well as to those more senior and leading in surgical services. It has been argued that such awareness about roles, as well as of practice limitations and statutory regulations, is pivotal ‘for safe patient care and effective working’ (Abraham et al 2019, p229).…”

Changing faces within the perioperative workforce: New, advanced and extended roles

“…Team dynamics and human factors are associated with errors in operating theatres (CQC 2018). Therefore, the culture and leadership within the operating theatres are essential to facilitate the integration of new roles to ensure patient safety (Abraham et al 2019). Kneebone et al (2006) reported that the successful development and implementation of the Surgical Care Practitioner (SCP) role required good clinical leadership and the involvement of clinical stakeholders from the outset.…”

“…However, currently the AA practitioners are unregulated, although the General Medical Council (GMC) has recently agreed to regulate AAs (Merrifield 2019). The AA role is consistently banded under the Agenda for Change (AfC) 7-8a (Abraham et al 2019).…”