[Delegation of GP Work to Qualified Medical Staff in Germany - An Overview]. / Delegation hausärztlicher Tätigkeiten an qualifiziertes medizinisches Fachpersonal in Deutschland - eine Übersicht.

AIM: To assure nationwide provision of family medical care, a greater involvement of non-physician healthcare professionals has been discussed in Germany for some time. Currently, there are various delegation models. The aim of this study is to provide an overview of existing delegation models in a German family practice setting and to investigate to what extent they are implemented in practice. METHOD: Internet search was made for delegation models for non-physician healthcare staff, and various experts were contacted in April 2014. Models that explicitly addressed family practice, involved continuing education of more than 80 h, and for which health insurance funds bore the costs, were taken into consideration. The models were judged in accordance with the PDCA implementation cycle (Plan-Do-Check-Act). RESULTS: 6 delegation models used in family practice were identified for which only 4 qualifications were still available in 2014. The duration, content and aims of the training courses differed markedly. Since 2015, training to become a NäPA non-physician practice assistant (or a VERAH healthcare assistant in the family practice if the necessary supplementary qualification is achieved) is the basic qualification for which costs are reimbursed. However, one important quality criterion for its broad implementation, namely evaluation, is missing in NäPA training. Only the VERAH qualification fulfills all quality criteria. CONCLUSIONS: In order to fully implement the delegation models and to strengthen and promote the healthcare assistant profession, the delegation models for which training costs are generally reimbursable should satisfy all quality criteria and also be subject to continual evaluation.

Expanded function allied dental personnel and dental practice productivity and efficiency.

This study examined the impact of expanded function allied dental personnel on the productivity and efficiency of general dental practices. Detailed practice financial and clinical data were obtained from a convenience sample of 154 general dental practices in Colorado. In this state, expanded function dental assistants can provide a wide range of reversible dental services/procedures, and dental hygienists can give local anesthesia. The survey identified practices that currently use expanded function allied dental personnel and the specific services/procedures delegated. Practice productivity was measured using patient visits, gross billings, and net income. Practice efficiency was assessed using a multivariate linear program, Data Envelopment Analysis. Sixty-four percent of the practices were found to use expanded function allied dental personnel, and on average they delegated 31.4 percent of delegatable services/procedures. Practices that used expanded function allied dental personnel treated more patients and had higher gross billings and net incomes than those practices that did not; the more services they delegated, the higher was the practice's productivity and efficiency. The effective use of expanded function allied dental personnel has the potential to substantially expand the capacity of general dental practices to treat more patients and to generate higher incomes for dental practices.

[Paradigm shift of German medicine by introduction of nurse practicioners. Does it make sense in view of experience in the United Kingdom?]. / Paradigmenwechsel in der deutschen Medizin durch die Substitution ärztlicher Leistungen. Sinn oder Unsinn angesichts der Erfahrungen in Großbritannien?

Germany wants to introduce some models to allow nurses to work in medical roles. Although hospital nurses worked hard during the last couple of years to concentrate on pure patient care and to detach themselves from medicine, a short additional training of 6-12 months duration is planned to allow them to work independently in well defined areas of medicine (high blood pressure, wound care, dementia, diabetes). However, success of such models has only been tested in a few studies. Study results and experience with such models in the UK - where these developments are much more advanced - are not only positive. Generally, work of nurses in medical roles does not make patient care less expensive and doctor´s work less onerous. The benefit lies more in an add-on effect to doctor´s care. Therefore, a close scientific surveillance of such models must be guaranteed and results must be considered without any kind of ideology.

Improving access to oral health care services among underserved populations in the U.S.: is there a role for mid-level dental providers?

Nearly one-third of U.S. citizens lack access to basic preventive and primary oral health care services, which is primarily the result of the high costs of care and the uneven geographic distribution of dental providers. This article examines the case for and against one possible solution to address these barriers to oral health care: the introduction of a mid-level dental provider (MDP) position within the dental field.

Midwives taking on more roles: the 1st on call project.

On reflection I agree that midwives should not take on further roles if they cannot give one-to-one care in labour, which was the main point in the motion debated at the RCM conference last year. This is not the case at the Trust I work, and therefore extending our role feels correct and possible. I am undertaking a piece of research regarding the project, called 'blurring the boundaries', which hopefully will be completed soon. Role changes areas -- not just users. The NHS Plan implies health professional should be trying to work in partnership and I believe the 1st on call project has enhanced that process.