1. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Antoinette de Bont The impact of extended professional roles on practice WONCA Istanbul October 24 h 2015

2. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Extended roles New independent profession(s)/al roles in new health care services – Case manager in a very specific clinical area: – Diabetes Nurse in specific technical skills – Dialysis technician with legal autonomy and clinical responsibility to work that used to be done by doctors. – Advanced nurse practitioner – Non–medical prescribers New dependent roles

3. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Methods Systematic literature review. Systematic analysis of policy documents (9 countries). Case studies (n=16, 160 interviews, 620 hours observation at hospital wards and GP practices). – Hearth disease, breast cancer, type II diabetes. Survey: All the health professionals (est.1260 per country) engaged along each pathway.

4. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Europe as our laboratory

5. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Changes in the care pathway: perceptions

6. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Integrated care Co-ordination of care with new general professional roles Care delivery with one specialist responsible for the care, supported by general nursing staff Physician-centred care Multiple specialists, supported by specialized nursing, technical and staff Expertise-centred care Generic roles  Increase share in health services Specialised roles Development medical and information technology

7. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Specialisation of care

8. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Perceptions of integration in Scotland

9. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Integrated care Co-ordination of care with new general professional roles Traditional care delivery with one specialist responsible for the care, supported by general nursing staff Physician-centred care Multiple specialists, based on the required expertise, supported by specialized nursing, technical and/or administrative staff Expertise-centred care

10. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Conclusions The number of extended roles has increased – Especially more specialised roles in health care – Also, but significant less, new general roles The number of extended roles could further increased – Physicians decide. – National regulation allow further task delegation. The number of extended roles will increase. – New technologies and new services will increase skill mix further

11. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Thank you www.abdn.ac.uk/munros

12. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Acknowledgements We thank o 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. o All those who supported and guided this work both within the MUNROS research project team and as external associates. o All the MUNROS research and project partners for their continuing collaboration in this research.

13. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Outcomes of new professional roles: a systematic review 1048 studies identified; 41 evaluation studies included – Specialist nurses 3/3 improved health care utilisation 5/6 improved patient information 4/6 improved patient satisfaction – Advanced nurses 5/5 improved clinical outcome 3/4 improved patient information 5/8 improved patient satisfaction Tsiachristas, A., Wallenburg, I., Bond, C.M., Elliott, R.F., Busse, R., van Exel, J., Rutten-van Molken, M.P., de Bont, A., the MUNROS team Costs and effects of new professional roles: Evidence from a literature review Health Policy 2015 doi: 10.1016/j.healthpol.2015.04.00110.1016/j.healthpol.2015.04.001