The practice and regulation of non-medical healthcare professionals in community-based and primary care: maintaining old landscapes or encouraging creativity?

Continuous exhortations to innovate and modernise health care are producing significant changes to the delivery of services, and far-reaching effects on how health professionals work in primary and communitybased care. Changes to services that have led to reductions in waiting times, increased patient choice, and encouraged community-based care are rightly applauded, but the systemic effect of these changes on the practice of healthcare professionals is somewhat lesswell planned and often leaves health professionals in a position of playing ‘catch up’. I wish to suggest and describe some strategic opportunities to re-energise the practice and regulation of non-medical healthcare professionals in primary care. To consider the necessary workforce in communitybased and primary care, there are two important points of focus. The first is the commissioning and employment of a new workforce, the second, the continuous professional development (CPD) and deployment of an existing workforce. The existing workforce is constantly replenished by new education commissions, and the required workforce is estimated to continue to increase somewhat over the next five years. The balance of where these staffwill work, in the acute or primary and community care setting, is less well articulated. As this paper is being written, significant changes are expected from the Lord Darzi second-stage review. Few if any stones have been left unturned by that review, and some issues previously thought of as ‘too difficult’ are being addressed. Tomorrow’s clinicians, education funding support and workforce planning are all under review, and the consequences could be far reaching. Are we doing things the ‘wrong way round’?