The provision of general medical services by non-medical health professionals: systematic review, survey and mixed methods study

End of project summary

Background

The National Health Service (NHS) in Wales and the rest of the UK is faced with significant pressures due to staff shortages and limited resources. To help ease the pressure on the NHS, a potential solution is to increase the number consultations carried out by healthcare practitioners who are not doctors. These include non-medical health professionals (such as nurses, pharmacists and physician associates) and allied health professionals (including occupational therapists and physiotherapists). This approach is known as ‘role substitution’ and is becoming increasingly used in general practices in Wales. Work was undertaken during a Health and Care Research Wales funded PhD studentship to explore the advantages, disadvantages and consequences of role substitution. 

Main messages

• GPs will always remain an integral part of primary care, they serve as the focal point of the multidisciplinary team and are needed to offer their skilled opinion and make final decisions in areas that remain uncertain for non-medical health professionals and allied health professionals.  
   
• There is some evidence that nurse-led care is cost-effective, but more evidence is needed about the cost-effectiveness of other types of non-medical healthcare professionals that are involved in role substitution such as occupational therapists and physiotherapists. This will ensure that NHS funding is used in the best possible way to provide good quality services to patients.  
   
• There are now many different types of healthcare practitioners working in general practices and this can sometimes be confusing for patients. More information about all the different types of roles and services that are available are needed. This will help patients make informed choices about their care.  
   
• Clearly defined roles, good communication and teamwork are important when expanding roles in general practice.  
   
• Receptionists who perform a care navigator role have an important role to play in the process of role substitution, they are important members of staff that provide the first point of contact to patients attending their general practice. More information on their role and the type of training that they receive is important to patients.