Non-medical practitioner roles in the UK: who, where, and what factors influence their development?
traditional health workforce roles are changing, with existing roles being extended and advanced, while new roles are being created, often undertaking duties previously completed by doctors, sometimes referred to as non-medical practitioners (NMPs).
to investigate which NMP roles exist within the UK, mapping distribution, and explore factors influencing their development and recruitment.
two descriptive, exploratory, online self-completed semi-structured questionnaires were used. One was sent to all NHS acute healthcare providers (n=156) and private/independent healthcare providers in England (n=90). A separate questionnaire collected data, using convenience and snowballing approaches, from NMPs across the UK. Quantitative data were analysed using descriptive and frequency statistics. Qualitative data derived from open questions and comments were analysed using content and thematic analysis.
healthcare organisations in England returned 23/246 useable questionnaires; 115 NMPs returned responses, 19 did not meet the criteria, leaving 96 useable responses.
seven NMP roles were identified, throughout the UK, with regional variation. Several factors influence the development and recruitment of NMP roles in England such as service delivery and national policies. Inconsistencies were noted in Agenda for Change pay banding. Many practitioners undertook NMP roles to progress their career clinically.
Healthcare reform was revolutionised by the NHS Plan (Department of Health (DH), 2000), with many drivers in the two decades since propelling the transformation (Box 1). Central to this transformation was the need to redesign the accessibility and delivery of clinical care to a 7-day service, while improving cost and patient experience. In addition, changes to doctor training (House of Commons Health Committee, 2008) and the reduction in doctor working hours to a 48-hour week (Independent Working Time Regulations Taskforce, 2014) have decreased the availability of doctors in clinical practice. Consequently, a radical reform of the healthcare workforce is being undertaken to extend and advance existing health professionals to undertake activities traditionally undertaken by doctors (Imison et al, 2016). Within England this has led to extensive consultation on developing a wider workforce strategy (Health Education England (HEE), 2017a). Similarly, Scotland, Wales and Northern Ireland have also developed and revised frameworks to support advancing practice in redesigning the wider healthcare workforce to ensure patient safety.
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