title: Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world?
abstract: World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries. Based on a framework of team organization across the care continuum, six national experts compare skill-mix, education and training, tasks and remuneration of health professionals within primary care teams in the United States, Canada, Australia, England, Germany and the Netherlands. Nurses are the main non-physician health professional working along with doctors in most countries although types and roles in primary care vary considerably between countries. However, the number of allied health professionals and support workers, such as medical assistants, working in primary care is increasing. Shifting from 'task delegation' to 'team care' is a global trend but limited by traditional role concepts, legal frameworks and reimbursement schemes. In general, remuneration follows the complexity of medical tasks taken over by each profession. Clear definitions of each team-member's role may facilitate optimally shared responsibility for patient care within primary care teams. Skill mix changes in primary care may help to maintain access to primary care and quality of care delivery. Learning from experiences in other countries may inspire policy makers and researchers to work on efficient and effective teams care models worldwide.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany. Electronic address: tobias.freund@med.uni-heidelberg.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Freund
authors.affiliation: Health Innovation Program, University of Wisconsin-Madison, United States.
authors.forename: Christine
authors.initials: C
authors.lastname: Everett
authors.affiliation: National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex) and University of Southampton Centre of innovation and Leadership in Health Sciences, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Griffiths
authors.affiliation: Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Québec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hudon
authors.affiliation: The Australian Health Workforce Institute, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Lucio
authors.initials: L
authors.lastname: Naccarella
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre and Knowledge Centre of Sustainable Healthcare, Nijmegen, The Netherlands; HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Miranda
authors.initials: M
authors.lastname: Laurant
mesh_terms: D001315:Australia; D002170:Canada; D004739:England; D005858:Germany; D009426:Netherlands; D024802:Nurse's Role; D010348:Patient Care Team; D010819:Physician's Role; D058007:Physicians, Primary Care / Q000193:education; D059017:Primary Care Nursing; D060926:Remuneration; D014481:United States
keywords: Nurse practitioners; Nurses; Primary health care; Review; Skill mix; Workforce