Inter-disciplinary working in British primary care teams: A threat to the cost-effectiveness of care?

This paper argues that the current trends in Britain towards larger, multi-disciplinary, primary healthcare teams is without a solid evidence base and potentially threatens the overall cost-effectiveness of the healthcare system. In developing this argument the factors driving skill mix change and the effects on primary care team structure are summarized, and consideration is given as to what evidence exists to support the cost-effectiveness of these developments. Then, it will be shown how such skills-mix change may alter the key attributes that underpin the overall cost-effectiveness of primary care-centred healthcare systems. The final section proposes a framework for future skill-mix evaluation, which explicitly draws attention to the need for systems-level, as well as patient- and practice-level assessment of outcomes.