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Skill mix in primary care

BMJ 1994; 308 doi: (Published 16 April 1994) Cite this as: BMJ 1994;308:993
  1. I Heath

    Subjects that breed euphemisms are usually contentious, and skill mix (reprofiling, grade mix, and multiskilling) is no exception. In her recent review of the topic, Leone Ridsdale has provided us with a much needed synopsis of the debate.1

    The pursuit of skill mix in the new NHS has divided managers and health care professionals. With staffing accounting for 70% of NHS spending and managers under pressure to cut costs, the attractions of giving tasks to the lowest grades of staff who can perform them are obvious. In such an environment professionals fear the gradual erosion of the quality of care2,3 and trade unions see the spectre of redundancy.4 The debate over skill mix has heightened the belief among health professionals that managers do not understand the complexity of their knowledge and skill.5

    The dangerously simplistic approach of the NHS Value for Money Unit's report Skill Mix in District Nursing did nothing to allay these fears.6 District nursing was reduced to a series of mechanistic tasks that could be counted and reallocated. In this model of skill mix highly qualified, …

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