Workforce substitution and primary care

David P Weller
Med J Aust 2006; 185 (1): . || doi: 10.5694/j.1326-5377.2006.tb00439.x
Published online: 3 July 2006

We must preserve the elements of our health care system that work well

All the signals in health care in the Western world point towards increasing demand and limitations on supply — a development driven by ageing populations, ever-increasing and sophisticated technologies and treatments, and a workforce that is less inclined to work the long hours of years gone by. There have been calls from governments for more flexibility in health care delivery. In the case of primary care, the arguments for substituting “traditional” general practitioner roles seem compelling — primary care in the United Kingdom and Australia is struggling to provide adequate access to care for a population with increasing needs. Surely we must expand our workforce to meet this need — especially if this can be achieved by employing less expensive health care providers?

  • Division of Community Health Sciences, University of Edinburgh, UK.


  • 1. Sibbald B, Laurant MG, Reeves D. Advanced nurse roles in UK primary care. Med J Aust 2006; 185: 10-12. <eMJA full text>
  • 2. Richards A, Barkham M, Cahill J, et al. PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care. Br J Gen Pract 2003; 53: 764-770.
  • 3. Spurgeon P, Hicks C, Field S, Barwell F. The new GMS contract: impact and implications for managing the changes. Health Serv Manage Res 2005; 18: 75-85.
  • 4. Parle JV, Ross NM, Doe WF. The medical care practitioner: developing a physician assistant equivalent for the United Kingdom. Med J Aust 2006; 185: 13-17. <eMJA full text>
  • 5. Woodin J, McLeod H, McManus R, Jelphs K. Evaluation of US-trained physician assistants working in the NHS in England. The introduction of US-trained physician assistants to primary care and accident and emergency departments in Sandwell and Birmingham. Final report. Birmingham, UK: University of Birmingham, 2005. Available at: %20final%20report.pdf (accessed Jun 2006).
  • 6. Goldacre M. Planning the United Kingdom's medical workforce. On present assumptions UK medical school intake needs to increase [editorial]. BMJ 1998; 316: 1846-1847.
  • 7. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457-502.
  • 8. Hooker RS. Physician assistants and nurse practitioners: the United States experience. Med J Aust 2006; 185: 4-7. <eMJA full text>
  • 9. Dunt D, Elsworth G, Southern D, et al. Individual and area factors associated with general practitioner integration in Australia: a multilevel analysis. Soc Sci Med 2006 Mar 6; [Epub ahead of print].
  • 10. Boggis AR, Cornford CS. General practitioners with special clinical interests: a qualitative study of the views of doctors, health managers and patients. Health Policy 2006 Apr 16; [Epub ahead of print].
  • 11. Wilkinson D, Dick ML, Askew DA. General practitioners with special interests: risk of a good thing becoming bad? Med J Aust 2005; 183: 84-86. <MJA full text>
  • 12. Wyatt JC, Sullivan F. eHealth and the future: promise or peril? BMJ 2005; 331: 1391-1393.
  • 13. UK Department of Health. Our health, our care, our say: a new direction for community services. White Paper. London: HMSO, 2006. Available at: (accessed Jun 2006).


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