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Skill-mix change and the general practice workforce challenge

David Kernick
Br J Gen Pract 2018; 68 (669): 176. DOI: https://doi.org/10.3399/bjgp18X695429
David Kernick
St Thomas Medical Group, Exeter. Email: david.kernick@nhs.net
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The recent editorial on skill mix (‘Skill mix change and the general practice workforce challenge’)1 demonstrated a depressing recycling of familiar themes that have been around since at least the start of the century.2 Inevitably, there will be major challenges when attempting to configure a system where there are conflicting demands of efficiency (what gives value for money?), equity (what is a fair distribution of our limited resources?), and affordability (how much have we got to spend?); that needs to be both resilient and innovative; and is free at the point of entry.

The editorial concludes with a more useful challenge, that ‘If changing skill-mix is the answer, what is the question?’ I’d like to suggest two. First, Is current healthcare research a self-sustaining activity that has an imperceptible impact compared with the resources invested in it? Second, why has a historically determined mix of skills continued that seeks to force the NHS into the disciplinary matrix rather than the more logical converse?

A more useful approach may be to view the meaningless policy imperatives such as transformation, modernisation, sustainability, and skill mix as defensive devices — gestures designed to avoid the harsh realities of our situation with its challenges, ambiguities, and paradoxes. At least we can then be in a better position to start an honest debate about the best way forward.

  • © British Journal of General Practice 2018

REFERENCES

  1. 1.↵
    1. Nelson P,
    2. Martindale A-M,
    3. McBride A,
    4. et al.
    (2018) Br J Gen Pract, Skill-mix change and the general practice workforce challenge. DOI: https://doi.org/10.3399/bjgp18X694469.
  2. 2.↵
    1. Kernick D,
    2. Scott A
    (2001) Economic approaches to doctor/nurse skill mix. problems, pitfalls, and partial solutions. Br J Gen Pract 52(474):42–46.
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British Journal of General Practice: 68 (669)
Br J Gen Pract
Vol. 68, Issue 669
April 2018
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Skill-mix change and the general practice workforce challenge
David Kernick
Br J Gen Pract 2018; 68 (669): 176. DOI: 10.3399/bjgp18X695429

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Skill-mix change and the general practice workforce challenge
David Kernick
Br J Gen Pract 2018; 68 (669): 176. DOI: 10.3399/bjgp18X695429
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© 2018 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242