Multidisciplinary Team Working toolkit

Determining your own team’s skill mix

Having ‘the right staff, with the right skills, in the right place at the right time’ and is a complex process that requires careful planning and support.  Leadership that involves everyone, including patients, and approaches to change management that look at the full picture and are open to all possible approaches can really help.  

What can I do to determine the skill mix of the current team in place?

The World Health Organisation (2000) guidance for determining skill mix in the health workforce emphasised that skill mix is not just a technical exercise. It is a method of organisational change which requires careful planning, communication, implementation and evaluation if it is to achieve its objectives and main approaches to this are included in the Main approaches to determining skills mix (PDF).

Nelson et al. classified skill-mix in general practice as:

• the range of competencies possessed by an individual healthcare worker
• the ratio of senior to junior staff within a role
• the mix of different types of staff in a team/healthcare setting.

Changing the skill mix in primary care. How do I do it?

Once you have identified the skill mix that your current team have, by adding this to the demand you face from patients that you have evaluated in the “Assessment and management of demand” section you can then determine if: 

• Your team members are all working at the top of their potential
• If you have the right mix of skill to cope with the demand from your unique population of patients.

If you identify gaps in your skills mix, or gaps in individual roles within the team, you then have the choice to alter the skill mix of the team. Skill-mix changes have been classified into three broad role modifications: 

• enhancement (for example, extension of a primary care practice nurse’s role without need for supervision); 
• delegation (for example, a GP transferring tasks to a physician associate under supervision); and finally 
• innovation (for example, a physiotherapist leading musculoskeletal clinics that provide a new/enhanced service in primary care).

Can we move workload to a more appropriate clinician?

A simple way to measure potential task substitution is using the alternative professional questionnaire for GP consultations (PDF) with your GPs for one week.

Systematic approaches to matching competences and skills required to job roles and training needs have been developed and deployed in England.  

Examples of these are:

• Calderdale Framework¹
• Skills for Health’s ‘Six Steps Methodology to Integrated Workforce Planning'
  

Other examples in the UK are described in the Nuffield Trust's 'Reshaping the workforce to deliver the care patients need' report.

Guide to introducing skill mix

Extend skills and knowledge to improve service efficiency and outcomes. Could tasks be allocated from one group of professionals to another? For example, practice pharmacists could perform repeat prescribing rather than GPs. Home visits performed by GPs can be done by Advanced Nurse Practitioners or primary care paramedics.

The primary care workforce commission (2015) recommend practices should:

• Analyse their clinical caseload in order to decide on the skills that will meet the needs of their population.
• Agree clear pathways and referral criteria for what each clinician will see and do, and ensure people fully understand their new roles and evaluate these together over time.  

To get ideas for what staff roles may work effectively in your practice, it may help to talk to other practices, your primary care network, CCG or local Federation and ask what worked for them, particularly for new staff roles that you may be unfamiliar with. They may be able to guide you to local support and resources as well as work collaboratively. 

There are opportunities for different staff to manage:

• minor illness
• musculoskeletal problems
• patients in the management of their long-term physical and mental conditions
• develop care plans
• medicines optimisation and reconciliation from hospital discharge letters and correspondence

An alternative to employing new staff can be to extend the skills of current staff. This can lead to more responsive care as well as a deeper appreciation of each team member’s skills. 

Reference:

1. Smith R, Duffy J. Developing a competent and flexible workforce using the Calderdale Framework. International Journal of Therapy and Rehabilitation 2010;17:254-62.