2.1. Skill mix

Demand for patient-led services is forcing practices to think carefully about the mixture of skills that their team possesses. The principle of employing staff who can provide the best, most effective care for patients, is set out in A Health Service of All the Talents: Developing the NHS Workforce, and emphasises the importance of:

  • team working across professional organisations and boundaries;
  • flexible working to make the best of the range of staff members’ skills and knowledge;
  • streamlining workforce planning and development, which stems from the needs of patients, not of professionals;
  • maximising the contribution of all staff to patient care, doing away with the barriers that state that only doctors and nurses can provide particular types of care;
  • modernising education and training to ensure that staff are equipped with the skills they need to work in a complex and changing NHS;
  • developing new, more flexible, careers for all staff; and
  • expanding the workforce to meet future demands.

Achieving a range of skills can help practices cope with an ageing population, address developments in the management of long-term conditions, meet contract requirements and help support practice-based commissioning.


  • Access to a healthcare professional may improve.
  • Frees up higher grade staff’s time to concentrate on therapeutic tasks.
  • Improving access will lead to improved patient satisfaction, helping to achieve the targets set by the PCTs.
  • Regular skill mix reviews can provide development opportunities for staff.


  • Patients may have concerns about lower grade staff taking on new roles.
  • Cost-effectiveness of the changes can be difficult to establish. A revised skill mix is not necessarily more cost-effective than more traditional care models.
  • A skill-mix approach can blur the role boundaries between staff, which may threaten professional identity – this could have an effect on teamwork.
  • Investment in training for the increase in role duties may be required.


These will vary depending on your need to employ additional staff or alter the contracted hours of your current staff.

The Wanless review suggested that up to 70% of the work done by a GP might be allocated to a general practice nurse (GPN). Healthcare assistants (HCAs) are also valuable posts being introduced in general practice, enabling nurses to take on more complex duties. For more information on how to safely and effectively introduce new roles, see the Working in Partnership Programme’s (WiPP’s) GPN and HCA Toolkits.

To get in touch with other practices that have made changes to their skill mix, see the WiPP Database of Good Practice.

Rate this information

You must be logged in to submit a rating.

You must be registered and logged in to request email alerts

Case studies

There are no case studies in this section.


Useful resources

There are no resources in this section.