Abstract
BackgroundDue to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation.MethodsA qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP.ResultsEmployment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs’ caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs.In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees’ motivation to start the master’s programme and GPs’ prior experience with PAs/NPs. Knowledge about the PA/NP profession and legislations was often lacking.ConclusionsRole standardisations, long-term political planning and support from professional associations are needed to support policy makers in implementing skill mix in primary care.
Highlights
Due to the increasing demand on primary care, it is debated whether there are enough general practitioners (GPs) to comply with these demands and whether specific tasks can be performed by other care providers
In the case that the Physician assistant (PA)/Nurse practitioner (NP) was formally employed at a General practitioners cooperative (GPC), we included a manager of that GPC
Study population A total of 32 physician assistants and nurse practitioners (PAs/NPs) started their training in general practices in September 2013 or in September 2014
Summary
Due to the increasing demand on primary care, it is debated whether there are enough general practitioners (GPs) to comply with these demands and whether specific tasks can be performed by other care providers. Changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. More patients with chronic complaints and reforms that shift care from hospitals to the community, the pressure on primary care is high [1,2,3]. It is debated whether there are enough general practitioners (GPs) to comply these increasing demands and whether specific tasks can be transferred to other care providers. The number of PAs/NPs in relation to GPs (headcount) is approximately 1 PA and 2 NPs per 100 GPs [15, 16]
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