Measuring skill mix in primary care: dilemnas of delegation and diversification

The purpose of this Discussion Paper is to examine the constraints upon, and opportunities for, spreading the workload of general practitioners (GPs) more effectively and efficiently among members of the Primary Health Care Tea, (PHCT). Current knowledge of GP activity is outdated and based on self-reporting by GPs and nurses using methods which may be unreliable. The policy background and the research background are briefly outlined before discussing methodologies for examining the activities of the PHCT and assessing whether tasks can be delegated. Attitudes to delegation and examination of outcomes are also addressed. The central concept of the proposed study design described here relates to delegation and the issues arising thereof, thus taking into account of the identification of tasks currently undertaken by one group of professionals which could be carried out by another group. If the study proposed here is able to demonstrate that delegation of at least some tasks is both feasible and acceptable, changes in health care delivery in general practice would be inevitable.