Processes supporting effective skill mix implementation in general practice: a qualitative study

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Abstract

Background
Health policy and funding initiatives have addressed increasing workloads in general practice through deployment of clinicians from different disciplinary backgrounds. However, there is limited evidence about how GP practices make everyday practical decisions about the distribution of work to different practitioners when implementing ‘skill mix’.

Aim
To examine how GP practices operate with increasingly diverse groups of practitioners.

Design and Setting
In-depth interviews, observations, surveys and focus groups conducted in five GP practices in England

Method
Case study practices were selected for maximum variation of the duration and diversity of skill mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients’ perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings.

Results
Introduction of a wide range of practitioners necessitated significant changes in how practices dealt with patients requesting healthcare, and these changes were not necessarily straightforward. Effective categorisation of patients’ reported problem/s and understanding of practitioners’ capabilities were necessary to match patients with practitioners. We identified individual and organisational responses that could minimise the impact on patients, practitioners and practices of imperfections in the matching process.

Conclusion
This study indicates that processes underpinning the redistribution of tasks from GPs to non-GP practitioners are complex. It is not clear how the necessary fine-grained adjustments will be made for practitioners working across multiple practices as practitioner employment under the Primary Care Network contract continue to increase.

Bibliographical metadata

Original languageEnglish
JournalJournal of Health Services Research and Policy
Publication statusAccepted/In press - 14 Mar 2022