Skill mix and case mix of Dutch GP practices: A norm for organisational health workforce planning?

Abstract

Background: Shortage of GPs and declining interest in solo practice in France pushed health authorities to support the skill mix pilot programmes and the development of team in primary care. This paper seeks to estimate the potential for task shifting in primary from doctors to other health professionals and to identify the skill mix with a focus on care provided for type 2 diabetes patients. Methods: A cross-sectional multi-centre study was carried out in 2012 in 128 GP practices in France, comprising data of all patients consulting with their GP one day a week from December 2011 to April 2012. Encounters where type 2 diabetes was one of the managed health problems were selected for analysis. Capacity for task shifting and the health professional groups involved were the main outcomes assessed. Results: From 8572 processes of care concerning 1088 encounters of patients with diabetes 21.9% (95% CI 21.1%-22.8%) were considered eligible for shifting tasks from GPs to other health professionals. Most of the transferable processes are related to health maintenance (32.1%) and cardiovascular risk factors. Multivariate analysis showed that educational processes or a long-term condition status were associated with increased transferability of tasks, whereas patients with higher intellectual occupations or those with two or more associated health problems were associated with lower transferability. In relation to the skill mix, most of the identified tasks (78.1%) could be transferred to nurses and about one third (36.7%) to pharmacists. Organisational context, payment model and inter-professional education are key factors to improve the skill mix of primary care services. Conclusions: A significant amount of care for patients with multimorbidity, including type 2 diabetes, could be transferred from GPs to other health professionals, mainly comprising tasks related to prevention and education of cardiovascular risk factors. 11th European Public Health Conference Winds of change: Towards new ways of improving public health in Europe Ljubljana, Slovenia, 28 November - 1 December 2018.