Expand the team – new and evolving roles
To build the team and more adequately meet the needs of your population, teams are benefiting from expanding to include new roles and team members. Some of the roles discussed here include clinical pharmacists, healthcare assistants and health coaches.
Over the last 30 years, the health needs of our communities have significantly changed. Ageing populations, unhealthy lifestyles, increased long-term conditions and medical advances are just some of the contributing factors. People are developing diseases earlier, more cancers are treatable or becoming long-term conditions, mental health conditions, multiple co-morbidities and polypharmacy are so common, and the overall health needs are increasingly complex.
Yet, health services only contribute approximately 20% to overall health and wellbeing. So much of health sits outside the influence of the health system as the impact of poverty, poor housing, environmental influences and social factors are increasingly recognised.
As a result, many conditions traditionally managed by hospital or specialist teams are now routinely managed in the community by general practice teams. Examples include diabetes, heart failure, COPD, atrial fibrillation to name a few.
To optimally manage the health needs of such populations, we now need a broader skill mix. Some of the roles that are making a difference for primary care teams include healthcare assistants, clinical pharmacists, community health workers, social workers and health coaches.
Healthcare assistants are non-health professionals or support staff who work collaboratively with the general practice team to meet the needs of the enrolled population, follow policy and procedures, and work under direction and delegation of a registered health professional. Healthcare assistants can work in numerous roles from providing practical support, stock management, patient information resource management, to patient education when appropriately trained and supported.
View more about healthcare assistants, Health Navigator NZ
Community health workers
Community health workers have been working in numerous roles for many years. More recently, some general practice teams are including community health workers (CHW) in the wider primary care team. This often works well when the CHW has the language and cultural knowledge of the local enrolled population. As an example, Porirua Union Community Health Service has a team of CHWs with diverse roles and cultural backgrounds to meet the needs of Maori, Pacific and refugee groups.
The role of the Health Navigators is becoming increasingly common and there are several examples to be found working as members of primary healthcare teams throughout New Zealand. The navigators' main role is to help people navigate around the system in both health and social care. Their role may include streamlining appointments, organising transport and other tasks to help the team as well as patients. Health navigators are also aware and have up-to-date knowledge of all the services available in their communities.
Pharmacists can play a key role in expanding the primary care team. Clinical Pharmacists can provide advanced-level medicines management services in a variety of practice settings including GP clinics and via Primary Health Organisations.
Read more about clinical pharmacists and their expanding role.
Expanded team: Poriria as an example
Porirua Union Community Health Service (PUCHS) employ a team of GPs, nurses, reception and admin staff as well as:
Community Health Worker
Healthcare Assistant (this is a part-time role undertaking tasks such as ordering stock, doing patient recalls, restocking consultation rooms etc. This has released a lot of the nurses’ time as these tasks used to be carried out by them).
They also have a number of visiting specialist health workers. The range of external specialist input reflects the needs of the relatively young enrolled population and an adult population carrying a higher than average burden of chronic disease. Team members include:
Pacific Health Navigator – calls in once each week to talk to staff and pick up a list of people who need following up or who have not attended appointments
Pharmacist (see case study)
Dietitian – employed by PHO attends clinic twice each week
Podiatrist – sees diabetes patients for no charge and sees non-diabetes patients for a nominal $3 charge
Mental Health Counsellor
Smoking Cessation Specialist – half a day 2 times per week
GP with special interest – runs a monthly minor surgery clinic and a medical specialist from the hospital also runs a monthly clinic
Diabetes Specialist – attends every 2 to 3 months and participates in a multidisciplinary clinical meeting followed by a clinic
Nurse Practitioner Child Health – visits once every 2 months to provide ongoing education to the nursing team and to see patients with persistent problems. Main problems are skin infections, respiratory problems and sleep.