Workforce gaps should not be filled by cheaper substitutes, says Peter Griffiths

‘Training up’ nurses for doctors’ roles and using healthcare assistants to fill in the gaps is risky, argues Peter Griffiths

The Nuffield Trust report on reshaping the healthcare workforce was published last month. Its conclusions were widely reported as a recommendation to ‘train up’ nurses as a solution to junior doctor shortages, with support workers, in turn, substituting for registered nurses.

Given that I started my research career exploring aspects of nurse-for-doctor substitution, it would be hypocritical of me to insist that practices and roles should be fixed and reserved for a single profession for evermore. However, we do need to be hugely careful.

The logic of allocating tasks or roles to the cheapest member of the workforce who can perform them might seem obvious, but the downsides, including lack of flexibility, increased number of handoffs and greater burden of supervision, are significant.

When we talk about the importance of flexibility in the workforce, we should remember that flexibility is a key advantage of having a highly


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