‘Lets join hands and jump together’: Readiness and implementation of skill mix change in general practice

Background: The last 10 years has seen major
changes in the ways general practices deliver
UK primary care services. In a context of skill
shortages, cost containment, policy reform,
quality improvement and increasing volume of
interventions delivered in primary care, new ways
of working are becoming the norm. Skill mix, such
the introduction of advanced nurse practitioners
(ANPs) and health care assistants (HCAs), has
fundamentally re-engineered the primary care
workforce (1).
Aim: This study explored the features of general
practices that successfully accommodate and demonstrate
readiness to re-design and implement
skill mix.
Design: Five GP practices serving different population
size, demography and geography participated
in a multi-case mixed methods study (2) design.
Team Climate Inventory [TCI-14] (3) was administered
to all staff. Following exploratory analysis
hierarchical regression modelling was undertaken.
Semi-structured interviews with ANPs, general
practitioners (GPs), practice nurses (PNs), HCAs
and business managers were analysed using
thematic analysis.
Findings: 122 clinical and non-clinical informants
completed the TCI-14. Mean TCI-14 scores
were consistently high (50.8 – 59.0) across all
subscales, for all practices, suggesting willingness
to work collectively toward shared goals. Size of
practice made no difference to mean scores, but
higher mean scores were associated with proportion
of clinical staff, years employed in the practice
(p=<0.001) and gender. Comparison of TCI-14
with patient experience Quality and Outcome
Framework (QOF) scores showed no significant
differences. The changing architecture of primary
care and role of skill mix in delivering patient
services emerged in the qualitative data.
Discussion: Organisational willingness, demonstrated
by TCI-14 score, may be an indication
of readiness to consider change. Case analysis
indicated no single change model was in operation
but openness, transparency, commitment and
maximising staff capability appeared to be attributes
associated with readiness.
Conclusion: This presentation will focus on
the conditions that contributed to successful
workforce re-design.