Sharing Responsibilities within the General Practice Team – A Cross-Sectional Study of Task Delegation in Germany

Abstract

BackgroundExpected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves.MethodsAs part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all.ResultsThe survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient’s condition, as the sole responsibility of a GP.The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief.ConclusionsIn Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have undergone special training, GPs seem to be prepared to delegate tasks that demand a substantial degree of know-how, such as home visits and case management. This “new” role allocation within the practice may signal a shift in the provision of health care by family practice teams in Germany.

Telemedizinische Methoden in der Hals-Nasen-Ohrenheilkunde

“…At the beginning of telemedical networks, the concern among physicians was great that substituting processes might lead to the situation that other medical staff could assume ENT specific activities. VERAH [65][66][67][68][69][70] or AGNES [65,[71][72][73] as well as other similar concepts were considered as possible models that might restrict the medical spectrum by connecting them with a telemedical network and shift them to the sector of general medicine. Due to the clear statement of the German Medical Association against substituting processes [18] on one hand, but also an increasing number or reports about the scope of duties of VERAH and AGNES, obstacles could be removed.…”

“…Since VERAH is primarily responsible for tasks from the area of organizational services, nursing and support with information on vaccination, prevention, follow-up examinations, and compliance, positive effects might be seen also for consultations of ENT specialists [66,67,70]. The implementation of this system to relieve general practitioners was rated positively by medical colleagues, treated patients, and supply assistants.…”

Primary care practice assistants’ attitudes towards tasking shifting and their perceptions of the challenges of task shifting – Development of a questionnaire

“…The agreement regarding task shifting of medical tasks typically performed by physicians to other non‐medical personnel in outpatient care, as described in §28 section 1 in the Social Security Code V, represents the first step towards task shifting regulated by law (Social Security Code § ). Different delegation projects have been initiated in Germany, such as VERAH (healthcare assistants in family practices), AGnES (general practitioner (GP)‐supporting, community‐based, e‐health‐assisted, systematic intervention) and NäPa (non‐medical assistants) (van den Berg et al, ; German Medical Association, ; Mergenthal, Beyer, Gerlach, & Guethlin, ).…”

“…Although task shifting has been allowed in Germany since 2008, uncertainties remain regarding the legal framework of tasks that can be delegated to practice assistants (Ruppel, Berg, & Hoffmann, ). Previous studies have revealed that the shifting of medical tasks to specially trained practice assistants could reduce the workload of physicians, strengthen the continuity and coordination of patient care and have a positive influence on patient satisfaction and compliance (Hooker & Everett, ; Martínez‐González et al, ; Mergenthal et al, ).…”

“…Only a few studies have examined how models of task shifting are being accepted and implemented in Germany, and the existing studies have primarily examined this topic from the physician's perspective (Dini et al, ; Mergenthal et al, ; van den Berg et al, ). To our knowledge, the practice assistant's perspective has received little attention until now.…”