Role shifts
Changes since 2000 in the economy, demography, and the health and social care system have created a drive and a need for getting health and social care staff fit for purpose. Traditional roles and role boundaries may no longer be relevant. There will be up, down, and side skilling of the workforce to introduce greater flexibility, and promote more effective and efficient care. Skills and competencies take on greater emphasis as role boundaries lose their importance.
The UK has a skills shortage because of increasingly complex demands for health and social care services. Demographic changes suggest that in the next five years, over two thirds of the current NHS workforce will have retired or require up-skilling. The services are also faced with a need to improve efficiency, provide a cost-effective service, and to deliver high quality care. The cost of staffing in health care can reach over 75 per cent of total costs. Effective skill and role mix can help make the most of available resources.
A change in the training of nurses, and other health and social care professionals leads to these individuals taking on some roles currently performed by doctors. Sources suggest that up to 70 per cent of the work done by GPs could be done by others. Patients, however, have expectations of their care, and tend to want to see a doctor.
As a result of the changes taking place – occupational boundaries are being redefined and renegotiated. Clinical tasks are being transferred or redistributed between different members of the team. There are trends of more nurses taking a leading role in some areas of care, e.g. hygiene or infection control, and this is likely to continue. The role of the doctor will focus much more on diagnoses and certain technical procedures, as well as managing complex teams and systems. These shifts in role boundaries happen both upwards and downwards. New roles such as assistant practitioners have already been introduced to fill workforce gaps and free registered nurses to take on new or expanding roles. The effects of up-skilling or role shifts circulate through the system.
Sources or references
- Interviews with healthcare professionals as part of the CfWI’s Medical and Dental Student Intakes project, 2012
- Workforce Service Reviews, Health Workforce New Zealand
- Brook, S and Crouch, R, Trauma, 2004, Doctors and nurses in emergency care: where are the boundaries now
- Buchan, J and Calman, L, OECD, 2005, Skill-Mix and Policy Change in the Health Workforce: Nurses in Advanced Roles Skills for Health, 2008, Career Framework Descriptors
Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.
