Skill-mix change in general practice: a qualitative comparison of three 'new' non-medical roles in English primary care (vol 69, pg 489, 2019)

Background General practice is currently facing a significant workforce challenge. Changing the general practice skill mix by introducing new non-medical roles is recommended as one solution; the literature highlights that organisational and/or operational difficulties are associated with skill-mix changes. Aim To compare how three non-medical roles were being established in general practice. understand common implementation barriers. and identify measurable impacts or unintended consequences. Design and setting In-depth qualitative comparison of three role initiatives in general practices in one area of Greater Manchester, England; that is, advanced practitioner and physician associate training schemes, and a locally commissioned practice pharmacist service. Method Semi-structured interviews and focus groups with a purposive sample of stakeholders involved in the implementation of each role initiative were conducted. Template analysis enabled the production of pm-determined and researcher-generated codes, categories, and themes. Results The final sample contained 38 stakeholders comprising training/service leads, role holders, and host practice staff. Three key themes captured participant& perspectives: purpose and place of new roles in general practice, involving unclear role definition and tension at professional boundaries; transition of new roles into general practice, invoking risk management, closing training-practice gaps and managing expectations; and future of new roles in general practice, involving demonstrating impact and questions about sustainablity. Conclusion This in-depth, in-context comparative study highlights that introducing new roles to general practice is not a simple process. Recognition of factors affecting the assimilation of roles may help to better align them with the goals of general practice and harness the commitment of individual practices to enable rule sustainability.