An increasingly common response to the challenges facing healthcare have been to extend the role of non-medical clinicians into areas that were previously the domain of doctors. There is an expectation that revision of roles will improve the effectiveness and efficiency of healthcare. But does it? To answer this question the Health Foundation has conducted new research which considers the impact of professional role revision on quality of care and outcomes.
The report Revision of professional roles and quality improvement: a review of the evidence, written by Laurant, M. et al, concentrates on two types of changes to professional roles, Substitution – exchanging one type of professional for another and Supplementation – extending the range of service provision within one health delivery system.
This report focuses on the revision of roles between doctors and:
advanced practice nurses such as nurse practitioners, specialist nurses, clinical nurses and practice nurses
physician assistants
pharmacists
allied healthcare professionals such as physical therapists (referred to as physiotherapists in this review), speech and language therapists, dietitians and paramedics.
Professional role revision has a number of aims: to reduce the medical workload; to increase capacity and extend the range of services available to patients; to improve the quality of care; and/or to reduce costs.
The evidence in the report finds that there is no detrimental effect of revising or extending the roles of non-medical professionals, and in some cases there is a positive effect on the quality of patient care. Gains in service efficiency may be achieved if doctors stop providing the services that are transferred to other health professionals and instead invest their time in activities that they alone can perform.
There are many challenges facing healthcare today including rising demand for healthcare, variations in access and quality, pressure to contain costs and medical workforce shortages.
The report has messages for the NHS, policy makers and researchers. It is also particularly relevant for those with strategic responsibility for workforce planning.