Revision of professional roles and quality improvement

Our latest Quality Enhancing Intervention report considers the impact of professional role revision on quality of care.  A full report and summary version are available for download.  

Background

An increasingly common response to the challenges facing healthcare has been to extend the role of non-medical clinicians into areas that were previously the domain of doctors. The rising demand for healthcare, variations in access and quality, pressure to contain costs and medical workforce shortages have led to increasingly prominent roles for other professionals in the provision of patient care. The expectation is that such revision of roles will improve the effectiveness and efficiency of healthcare. But does it?

About this report

Our report, Revision of professional roles and quality improvement: a review of the evidence, considers the impact of professional role revision on quality of care and outcomes. It focuses on two types of changes to professional roles:

• Substitution – exchanging one type of professional for another.
• 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.

Our 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.  

Who should read this report

Our report is of relevance to those with strategic responsibility for workforce planning and has messages for the NHS, policy-makers and researchers. 

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