Skill mix, roles and remuneration in the primary care workforce: Who are the healthcare professionals in the primary care teams across the world?

Abstract

World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries. Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from 'task delegation' to 'team care' is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession. Clear definitions of each team-member's role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide.

Scope of practice in Primary Care: physicians and nurses in five health regions in Brazil

“…[2][3][4][5][6][7][8][9][20][21][22][23] In any case, if it is not obvious, the results presented in this exploratory study reinforce the importance to reform the regulations of health professions in Brazil. This reform would implicate on the extrapolation of activities legally defined and should take into account the context of practice, including city norms and protocols, the levels of competence and experience of the professionals, as well as the patients' necessities and demands.…”

“…2,[5][6][7] The Atenção Primária em Saúde (APS) (Primary Health Care) in several countries has gone through significant changes with respect to the number and types of health professionals and their roles in the health services. 8,9 Countries such as Australia, Canada, the United States and England are reviewing of the scope of health professions, seeking each time more in optimizing their workforce, reducing costs, providing greater equity and quality in service provision, mainly in regions that present shortage of these professionals. Strategies were adopted by these countries including the adoption of new health professions, as for example physician assistants, nurse practitioners; the function transference between professional with hight category level or technical category level -task shifting or skill mix, as nurses performing certain medical procedures; the expansion of primary care health professionals scope of practice, as physicinas performing tasks usually attributed to specialists.…”

“…Strategies were adopted by these countries including the adoption of new health professions, as for example physician assistants, nurse practitioners; the function transference between professional with hight category level or technical category level -task shifting or skill mix, as nurses performing certain medical procedures; the expansion of primary care health professionals scope of practice, as physicinas performing tasks usually attributed to specialists. [9][10][11][12][13] In Brazil, the APS is the preferential entrance to the Sistema Único de Saúde (SUS) (Public Health System) and the scope of practice for health professionals who work in this context influence directly the referrals rates and lines at secondary and tertiary care and, consequently, costs and access to health. 5 Due to this, the processes of regulation and workforce training, along with the reform models of service provision, mainly in primary care, has, over the past few years, been at the center of the policy agenda of Human Resources for Health in Brazil.…”

Addressing the Needs of an Aging Population in the Health System: The Australian Case

“…24 The initiative also provided for reimbursement of specific services provided by registered nurses on behalf of GPs. 25 New referrals flowed to physiotherapists and podiatrists in the largest numbers as a consequence, followed by dieticians. 26 However, the uptake of the program has been low over the years, with the average GP preparing 22 chronic disease management plans per year.…”

“…30 Studies also suggest a move away from general practitioners working alone and providing episodic opportunistic care toward greater focus on prevention and early intervention, and structured chronic disease management within multidisciplinary care team approaches. 25 The 2012 Australia…”