Skill mix between nurses and doctors working in primary care-delegation or allocation: a review of the literature

The fundamental role of primary health care teams (PHCT) is to deliver effective services to the local population. Demands on the PHCT have increased since the early 1990s and, with the advent of Primary Care Groups (PCGs), will continue to do so in a primary health care led National Health Service (NHS). Rapid changes, however, raise questions about the feasibility and delivery of new services with skill mix and the distribution of workload within the PHCT being key issues. This paper reviews the literature on workload in primary care, attitudes to delegation, inter-professional relationships and teamworking and concludes that in order to deliver the vision of a primary care led NHS, meet the health care needs of users, address the inevitable anxieties of general practitioners and bring forth the professional aspirations of nurses and other health care professionals, more equitable and less hierarchical models of multi-professional teamworking in primary care will be most successful.