Skill-mix change and the general practice workforce challenge

The recent editorial on skill mix (‘Skill mix change and the general practice workforce challenge’)¹ demonstrated a depressing recycling of familiar themes that have been around since at least the start of the century.² Inevitably, there will be major challenges when attempting to configure a system where there are conflicting demands of efficiency (what gives value for money?), equity (what is a fair distribution of our limited resources?), and affordability (how much have we got to spend?); that needs to be both resilient and innovative; and is free at the point of entry.

The editorial concludes with a more useful challenge, that ‘If changing skill-mix is the answer, what is the question?’ I’d like to suggest two. First, Is current healthcare research a self-sustaining activity that has an imperceptible impact compared with the resources invested in it? Second, why has a historically determined mix of skills continued that seeks to force the NHS into the disciplinary matrix rather than the more logical converse?

A more useful approach may be to view the meaningless policy imperatives such as transformation, modernisation, sustainability, and skill mix as defensive devices — gestures designed to avoid the harsh realities of our situation with its challenges, ambiguities, and paradoxes. At least we can then be in a better position to start an honest debate about the best way forward.