1. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Changing skill mix within teams delivering integrated health services Antoinette de Bont, April 3 rd 2014

2. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Agenda The need for an integrated planning model for the workforce – New professional roles can increase fragmentation of care; – The development of new professional roles in Europe – Drivers for new professional roles Evidence for better care with new professional roles How the MUNROS study can contribute

3. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros New professional roles in Europe Existing professions that specialize in a very specific clinical area: – Extended roles. – Diabetes Nurse in specific technical skills – Technical roles. – Dialysis technician in new health care services – Advanced roles. – Case manager New professions with legal autonomy and clinical responsibility to work that used to be done by doctors. – Advanced nurse practitioner

4. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Where do the EU stand New professions in Netherlands, England and Scotland. Extended roles and new technical roles in Germany, Italy, the Czech Republic and Turkey. Very few new professional roles in Norway and Poland.

5. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Drivers that encourage Dedicated policies to encourage skill mix change; The emergence of new services in response to technical services; Educational programs hamper Payment systems that put physicians center stage Hierarchical differences between physicians and nurses Skill mix

6. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Evidence for the better Out of Forty five evaluation studies of specialist nurses (SNs) and advanced nurse practitioners (ANPs): – 57% of the SN evaluation studies and 66% ANP studies reported improvements in quality of care. – 80% of the SN evaluation studies and 57% ANP studies reported improvements in patient satisfaction. – 60% of the SN evaluation studies reported reduction in health care utilization.

7. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros How Munros can contribute An integrated model to plan all professional roles in a care pathway based upon empirical evidence about: – The quality of care; – The costs of care; – The substitution of task; – The integration of care; Our pathways: diabetes II, breast cancer and acute myocardial infarct.

8. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Acknowledgement We wish to thank the European Commission for funding this research programme ‘Health Care Reform: The iMpact on practice, oUtcomes and cost of New ROles for health profeSsionals (MUNROS), under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) grant agreement number HEALTH-F3-2012- 305467EC.