ABSTRACT
The move towards a primary care-led NHS implies an expansion in the numbers and types of staff working within primary care, and the development of new professional roles. This chapter outlines key issues which need to be considered as the move towards a primary care-led NHS increases innovation and experimentation with the disciplinary mix and roles of general practice teams. The management of general practice services has undergone rapid change in response to the NHS reforms of the 1990s. Health service managers under pressure to make year on year efficiency gains are sometimes compelled to alter staff skill mix in the absence of objective evidence of how this may affect the quality or cost-effectiveness of service provision. The quality and cost-effectiveness of health service provision may therefore suffer if nurses, specialists and professionals allied to medicine substitute for general practitioners (GPs) in providing first-contact care.
