Aim: Describe how new health care professionals are deployed iMpact on practice oUt comes and costs of New ROleS for health professionals Professor Christine Bond, University of Aberdeen on behalf of MUNROS team Aim: Describe how new health care professionals are deployed Explore effect of skill mix on costs and outcomes Make recommendations for workforce planning

Project overview high prevalence significant morbidity and mortality national guidelines acute, chronic and surgical condition Mapping health system integration, skill mix and competencies Understanding health systems Mapping skill mix Methodology and Study Design Case studies Questionnaire design Data Collection, Management and Analysis Impact on clinical practice and organisation of care Outcomes: the Patient Experience Outcomes: Process, Productivity and Clinical Effect Changes in Costs and Benefits Translation into Policy: Delivering Impact New Professional Roles and the Integration of Care Management of Human Resources and Successful Workforce Planning Scientific Structure, Policy Engagement, Impact and Dissemination Heart disease (STEMI) Breast cancer Type2 diabetes

Project overview high prevalence significant morbidity and mortality national guidelines acute, chronic and surgical condition SURVEYS and ROUTINE DATA -12 hospitals (teaching; large general; other general; city/urban/small town/rural) -Associated general practices -Health care professionals/-Health care managers: Demographics, Educational qualifications, Hours worked, Perceptions of integration and specialisation, Drivers and barriers, Factors influencing decisions, What they do! -Patients: Demographics, health care utilisation, experiences, satisfaction, perceptions Mapping health system integration, skill mix and competencies Understanding health systems Mapping skill mix Methodology and Study Design Case studies Questionnaire design Data Collection, Management and Analysis Impact on clinical practice and organisation of care Outcomes: the Patient Experience Outcomes: Process, Productivity and Clinical Effect Changes in Costs and Benefits Translation into Policy: Delivering Impact New Professional Roles and the Integration of Care Management of Human Resources and Successful Workforce Planning Scientific Structure, Policy Engagement, Impact and Dissemination Heart disease (STEMI) Breast cancer Type2 diabetes

Task list: breast cancer example Stage Area of activity Task Diagnosis Imaging ultrasound Imaging mammogram Do mammogram Radiological interpretation Clinical interpretation Admin. Work eg result reporting Imaging MRI Biopsy Assessment Inform patient Carrying out surgery/managing therapy Surgery Chemotherapy Radiation therapy Endocrine Biological Follow up/managing complications Palliative care

Early findings Care pathways and team composition are changing External drivers are mostly professional influences and need for service redesign Professionals also highlighted new legal rights Managers make team composition decisions on staff skills and competences, staff experience and regulation Budgets and perceptions of patient preferences least important Patients are satisfied Experience of care suggests it is not ‘patient centred’ Care feels integrated but doctor is often still seen as ‘main’ provider Next steps Inter and intra country comparison Cost effectiveness and clinical effectiveness Recommendations for optimal team Workforce planning tool

Issues for research Engaging clinical colleagues Differences in health systems, definitions, terminology across European countries Distinguishing exact contribution to health care delivery to quantify substitution Dynamic workforce context Generalisability beyond three conditions

Acknowledgements We thank European Commission for funding this research programme ‘Health Care Reform: The iMpact on practice, oUtcomes and cost of New ROles for health profeSsionals (MUNROS), under the European Community’s Seventh Framework Programme (FP7 HEALTH-2012-INNOVATION-1) grant agreement number HEALTH-F3-2012-305467EC . All those who supported and guided this work both within the MUNROS research project team and as external associates. All the MUNROS research and project partners for their continuing collaboration in this research.