Table 3 Primary healthcare workforce

NHS systems

Denmark

1. Main professions: GPs, nurses, health, and social care assistants/helpers. Some skill-mix, task-shifting and new roles of nurses have been established

2. GPs and nurses are academically trained with mandatory specialisation for GPs and voluntary PHC-related specialisation for nurses (advanced practice nurses, community nurses). Care assistants are trained vocationally

3. Sector-specific labour market data are available for all relevant PHC groups. Comprehensive planning has been established at the regional and/or national levels for all PHC groups

Portugal

1. Occupational groups depend on the type of PHC. Family health units (largest type) consist of multidisciplinary teams, comprising of specialised physicians (GPs/family medicine), public health physicians, nurses (both generalists and those specialised in community and public health), technical officers in environmental and public health, social workers, physiotherapist, occupational therapists, psychologists and nutritionists, dentists, and clinical secretaries. Task-sharing and shifting remains limited and is only described among physicians and nurses

2. GPs, nurses and other professionals are academically educated with mandatory specialisation requirements for GPs, for all other professions this is voluntary

3. Labour market data are not disaggregated for PHC and professional groups, except for GPs. Major trends include shortages, reinforced by ‘ageing cohorts’. No reliable HCW migration data is available, but a negative migration balance has been predicted and rather stable inflows of foreign-trained/born HCWs are common. Publicly available data is limited, and no systematic monitor and planning has been established

UK/England

1. The PHC team is multi-professional; the composition depends on organisational setting. In Primary Care Networks, major HCW groups include GPs, nurse practitioners and healthcare assistants, supported by pharmacists, physiotherapists, mental health specialists, community nurses, and social workers. Some skill-mix, task-shifting and new roles of nurses have been established

2. GPs are academically educated with mandatory specialisation. Nurses and other middle-level professional groups are academically trained, and practice nurses and physiotherapists can obtain master’s degrees and specialisations, while healthcare assistants mainly obtain vocational training degrees, diplomas or are trained at the job

3. Labour market figures are available and disaggregated for most PHC groups, showing GPs as the largest group followed by healthcare assistants and practice nurses. A shortage of HCWs has been common for years and worsened for GPs; however, the numbers of other HCW groups (physiotherapists, mental health specialists, social workers) have increased. Health Education England and NHS England collaborate on HCWF planning and have established monitoring systems that include GPs and some other HCWs

Established SHI systems

Germany

1. Main professions: GPs together with some internal medical specialists and paediatricians who opted for Family Care, and medical assistants. Nurses are not typically employed in PHC (some exceptions). Multi-professionalism is more common in larger PHC centres

2. Academic education with mandatory specialisation is required for GPs, but not available for other groups. Nurses and other middle-level professionals are mainly educated in the vocational system and academisation remains weak. Vocational education (3 years) is required for medical assistants; some certificate-based PHC (community nurses) training is available for medical assistants and nurses but rarely taken

3. Labour market figures are not disaggregated for PHC. GP figures may be estimated from public statistics, while the Medical Chambers obtain data for medical assistants (the largest group). Comprehensive PHC workforce monitoring and planning are not established, and SHI Physicians Associations are legally responsible for PHC planning

Netherlands

1. Main professions: GPs, GP practice nurses, midwives, pharmacists, and physiotherapists. Skill-mix and new roles of nurses and other middle-level professional groups have been established; midwives, pharmacists and physiotherapists are independent providers (direct access)

2. The academic education of physicians is required with mandatory specialisation of GPs. In nursing, academic training co-exists with vocational schools; voluntary specialisation is available for GP practice nurses (comparable to Nurse Practitioners), but not for other groups

3. Labour market figures are not disaggregated for PHC, and the number of physicians can be estimated from GP figures. Comprehensive workforce planning is in place, but it is focused on physicians and does not consider sector-specific issues. A national advisory board, under the control of the Ministry of Health, is legally responsible for the monitoring of a wide range of professions

Switzerland

1. Main professions: GPs with some paediatricians and internal medicine physicians, and gynaecologists. Medical assistants form the largest group, while nurses are an exception. Task-shifting is generally weak with some skill-mix in physiotherapy followed by a few nurses, dietitians and occupational therapists. New roles and more advanced skill-mix are limited and largely absent

2. Academic education and specialisation of GPs is mandatory; however, no specialisation is available for other HCWs. The academic education of nurses is increasing but co-exists with vocational training. Medical assistants are educated in the vocational system (3 years)

3. Labour market figures are not available for the PHC sector, except for GPs. A systematic monitoring and planning system is missing

Emergent SHI systems in Central Eastern/ Eastern Europe

Kazakhstan

1. Main professions: GPs and specialised physicians, district therapists, paediatricians, PHC nurses, midwives, physician assistants (Feldshers), social workers, and psychologists. The PHC workforce is multi-professional, but the composition varies strongly. A typical PHC team comprises of three PHC nurses per physician along with social workers and psychologists. In rural areas physician assistants and midwives build the core team. Expanded and new roles of nurses and task-shifting/skill-mix have been introduced

2. Education and training for all PHC staff improved significantly, unqualified PHC providers are largely suspended. PHC specialisation is established for physicians and nurses, and some facilities introduced multi-disciplinary training courses

3. Labour market figures show a continuing increase in relevant groups in PHC. The share of GPs in relation to specialists also increased but specialised providers remain dominant. Planning and monitoring operate under the umbrella of the Republican Center for Health Development and are based on the Registry of Medical Workforce, a unified database maintained by the Observatory of Medical Workforce. There is no comprehensive sector-specific data, but it can be estimated for GPs and other predominantly PHC-based groups

Romania

1. Main professions: GPs, nurses, community nurses, health mediators, school physicians and nurses, and support staff. Community health nurses are a relatively new and small group, contributing to providing care especially to elderly and other vulnerable groups, mostly in rural/remote areas. Very little task-shifting has been established

2. GPs are academically trained with mandatory specialisation, but there is little academisation of nurses and other groups, and no PHC specialisation is available

3. Sector-specific PHC workforce data are not available except for GPs. Planning is modestly developed and hampered by different and insufficiently connected data sources

Serbia

1. Main professions: GPs (with and without specialisation) and specialised physicians, nurses, and a wide range of multi-professional staff (dentists, pharmacists, psychiatrists, health laboratory technicians, physiotherapists, radiology technicians, social workers, administrative staff). Task-shifting is largely absent

2. Physicians are academically educated with voluntary specialisation for GPs. Nurses are mostly educated in a secondary-school system with some academic training being established, while PHC specialisation is lacking for all groups except physicians

3. Labour market data are disaggregated for PHC providers operating under the Network Plan Centres and public data on other/private providers are lacking. The share of specialised physicians is significantly higher than the number of GPs. Nurses are the largest group with numbers about ten times as high as GPs and specialists. Some centralised workforce planning has been established but hampered by poor and scattered data. The Law on Records in Health Care includes the Network of PHC providers with data collected through the Public Health Institutes, and additional information from the Register of Health Care Providers and Register of Employees