How can skill-mix innovations support the implementation of integrated care for people with chronic conditions and multimorbidity?

• The increasing and changing demands of complex patients (with chronic conditions and multimorbidity), combined with growing workloads and shortages of primary care providers, demand the reorganization of services for more patient-centred and more efficient care.
• Reorganizing health and social care services to integrate care requires that the health workforce adopt “skill-mix changes” including reskilling; a different approach to sharing tasks and roles; and improved coordination.
• Skill mix changes typically involve innovative re-allocation of tasks between professions; new supplementary roles; and/or the introduction of greater teamworking and flexibility.
• The most promising skill-mix innovations for improving integration of care of patients with complex needs are:

(1)    Shifting tasks and roles to achieve new divisions of work with advanced practitioners (nurses and pharmacists) taking on management of aspects of care and coordinating processes in close collaboration with physicians.

(2)    Relocation of care to other settings for example to nurse-led clinics or patients ...