Can Skill-Mix Dynamics Alleviate the NHS General Practice Workforce Crisis?

Frustrated, overworked-looking male healthcare professional in his office.

The NHS, a longstanding symbol of pride for its comprehensive healthcare coverage and dedicated professionals, now faces an unprecedented challenge: a severe shortage of healthcare workers. As the demands on this vital institution continue to escalate, the question looms large – how can the NHS meet the healthcare needs of the nation, given the scarcity of healthcare professionals?

This article delves into the current crisis, explores the potential of skill-mix approaches as a solution, and outlines the probable challenges involved in their implementation.

Understanding the NHS Workforce Crisis

Understanding the severity of the workforce crisis faced by the NHS requires an examination of its underlying causes:

  • Aging Population: The UK’s aging demographic puts immense pressure on healthcare services, as elderly individuals typically require more medical care.
  • Pandemic Pressures: The COVID-19 pandemic exacerbated the shortage, with healthcare workers pushed to their limits, leading to burnout and attrition.
  • Poor Retention: High turnover rates and difficulties retaining healthcare staff within the NHS aggravate the workforce shortage, creating a continuous cycle of recruitment and training.
  • Deteriorating Wellbeing: The mental and physical well-being of healthcare professionals has suffered due to the relentless demands of their roles, further contributing to attrition.
  • Outdated IT Provision: Outdated technology infrastructure can impede efficient healthcare delivery and frustrate staff, affecting their job satisfaction.
  • Bureaucracy: The administrative burden within the NHS can hinder productivity and discourage potential healthcare workers.

The shortage of healthcare professionals in the NHS is not a mere hiccup; it’s a monumental challenge that has been building for years. While the strain on the healthcare system is evident through longer waiting times, overcrowded emergency departments, and stretched resources, perhaps the most acute manifestation of this workforce crisis is the shortage of GPs. According to projections by the REAL Centre, the current shortage of qualified, permanent GPs is poised to worsen significantly over the coming decade. Currently, there is a deficit of approximately 4,200 full-time equivalent GPs, a number expected to surge to around 8,900 by 2030/31 (in relation to the number required to meet the constantly rising need for care).

Multiple patients in hospital waiting room.

The Potential of Role Expansion

As the NHS grapples with a multifaceted workforce crisis, the strategic expansion of roles through staff training and skill-mix approaches emerges as a promising solution of profound significance in addressing the challenges faced by the organisation.

Skill enhancement is not a novel concept in healthcare; it is deeply ingrained in the ethos of healthcare professionals and embodies the commitment to ongoing learning and professional development throughout one’s career. In a rapidly evolving field like healthcare, where medical knowledge and technologies constantly advance, staying updated and adaptable is not just a choice but an imperative.

Ongoing training and education ensure that healthcare professionals remain at the forefront of these developments, enabling them to provide the best possible care to patients. This approach directly impacts the quality of patient care by ensuring that healthcare providers are well-prepared to deliver evidence-based and efficient treatments. It also opens doors to career advancement opportunities, empowering professionals to take on expanded roles and responsibilities.

In an environment where healthcare workers are often stretched to their limits, continuous training and education transform them into adaptive professionals empowered to not only meet the immediate needs of the healthcare system but also drive innovation and improvement.

Exploring Skill-Mix Approaches

Skill mix in healthcare through continuous education can have a multifaceted impact. Healthcare professionals with diversified roles can provide a wide range of services, leading to more comprehensive and efficient patient care. By utilising the full scope of their skills, professionals can help optimise resource allocation within the healthcare system. With a larger pool of professionals capable of handling various tasks, patient wait times can be reduced, ensuring timely access to care.

For instance, pharmacists, who have traditionally been associated with dispensing roles, hold the potential for a broader impact. Research highlights their ability to contribute positively to clinical outcomes in primary care, underscoring their capacity to provide valuable patient care beyond conventional roles. Additionally, professionals such as nurse practitioners can also extend their roles to meet the ever-growing needs of patients.

The expansion of healthcare roles has the potential to directly improve patient care. Patients would have greater access to a variety of services, reducing the burden on specialised professionals and ensuring that individuals receive care tailored to their specific needs.

Two doctors, a nurse, and a senior female patient in wheelchair in hospital corridor.

In the evolving landscape of the NHS, steps towards the transformation of healthcare roles have already been made. Clinical pharmacists, integrated into general practice teams, exemplify this. In accordance with The NHS Long Term Plan, they assist the public in various ways, including by conducting structured medication reviews for patients with ongoing health issues, enhancing outcomes and accessibility to care.

Moreover, earlier this year, a new plan was launched, urging patients to utilise high street pharmacies for some common prescription drugs, including antibiotics, and routine tests. This initiative is expected to free up approximately 15 million GP appointments over the next two years, constituting around 2% of the total. The recovery plan promises to overhaul stretched GP services by redistributing some of the workload to other parts of the health service.

The Earwax Removal Example

One notable illustration of how skill-mix approaches can expand the availability of services lies in the field of earwax removal. In recent years, access to this service through GP practices has become unavailable due to various factors, including the increasing demand for GP services and budget constraints within the NHS. This has left individuals with no choice but to turn to private providers, which can be not only financially burdensome, but also potentially risky. The allure of earwax removal as a lucrative career has drawn the interest of many, leading some individuals to attend earwax removal courses with the aim of becoming certified to perform the procedure themselves. However, it’s important to note that the practice of earwax removal is not currently regulated, raising concerns about the adequacy of training and qualifications for those entering this field.

The concept of continuous education programmes presents an opportunity to empower NHS healthcare professionals, particularly pharmacists, with specialised skills, including earwax removal techniques. Through the provision of comprehensive training to staff delivered by certified providers, this valuable service can be made available within community pharmacies. The potential introduction of pharmacist-led earwax removal would bring several distinct advantages. It would offer patients the convenience of accessing safe treatment, addressing a service gap created by the strain on primary care facilities and showcasing how the NHS can proactively address similar challenges. Furthermore, patients could conveniently visit NHS pharmacies, where consultations with pharmacy staff are often available on a walk-in basis, unlike many private providers.

Female audiologist performing water irrigation on senior male patient

Challenges and Solutions

While the prospect of implementing skill-mix approaches within the NHS presents significant promise, it also comes with its fair share of potential hurdles.

  • Resource Allocation

One notable challenge pertains to resource allocation. The NHS, like many healthcare systems, faces budgetary pressures, making it challenging to invest substantially in continuous education initiatives. This financial constraint can hinder the development and implementation of effective continuous education programmes, preventing professionals from accessing the training required to expand their roles.

To overcome the resource allocation challenge, government support plays a pivotal role. Financial backing from governmental bodies can provide the much-needed resources to invest in continuous education programmes. Such investments can yield long-term benefits, including addressing workforce shortages and enhancing patient care through skill-mix approaches.

  • Role Enmeshment Issues

Resistance to change is an inherent aspect of healthcare systems. Encouraging healthcare professionals to embrace new roles and responsibilities can be met with scepticism and reluctance, often rooted in the deeply entrenched practices of the healthcare industry. Furthermore, the mixing of skills can lead to role blurring and overlapping, potentially causing tension, service gaps, or duplicative efforts.

To effectively address the potential issues related to role expansion, careful planning and strategic definition of emerging roles are essential. The NHS can proactively plan and execute role expansion initiatives, ensuring that new responsibilities are well-defined within the evolving healthcare structure. Additionally, employer incentives can serve as powerful motivators to encourage healthcare professionals to participate in continuous education and adapt to their evolving roles. These incentives can include offering career advancement opportunities, additional benefits, and recognition for their commitment to ongoing learning and skill development.

  • Threat to Quality of Care

A crucial challenge emerges concerning the training and competence of healthcare professionals as roles within the NHS expand and evolve. A study by University of Manchester researchers has revealed that the employment of non-medical staff within clinical roles has been linked to negative effects on patient satisfaction, reporting that despite increasing capacity, skill mix changes can also reduce quality of care. Indeed, the expansion of responsibilities may lead to healthcare professionals entering new domains without sufficient training and competence, potentially posing risks to patient safety.

To address this, comprehensive training and continuous education are essential. The NHS can proactively plan and execute role expansion initiatives, ensuring that healthcare professionals receive the necessary training to perform their expanded roles competently.


Skill mix approaches within the NHS hold immense promise as a strategic response to the formidable challenges faced by the healthcare system. While they may not provide a complete fix, they play a pivotal role in reshaping and revitalising the healthcare landscape.

To ensure the success of these approaches, one fundamental factor that comes to the forefront is the sufficient training and the acquisition of essential skills and knowledge of healthcare staff. Furthermore, skill-mix approaches within the NHS cannot be treated as a standalone tactic; they must be coupled with efforts to address funding shortages and recruit additional healthcare professionals, ensuring a robust workforce.

It is paramount to acknowledge that these transformations require meticulous planning. Every facet of change, from role definition to skill development and resource allocation, needs to be thought out well. It is a complex endeavour that hinges on collaboration and strategic foresight, but it also has the power to transform challenges into opportunities, paving the way for a stronger healthcare system – one that is agile, adaptable, and better equipped to meet the evolving needs of patients.

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