SHIFTING BOUNDARIES IN PROFESSIONAL CARE

The nature of the work undertaken by different health professionals an d inter-professional boundaries are constantly shifting. The greater k nowledge of users of health care, and the increasing technical and org anizational complexity of modern medicine, have partly eroded the cont rol of health professionals over the substance of their work. The defi nition of a field of work as lying within the province of any one prof ession is culturally rather than scientifically determined. It is evid ent that care of good quality should be delivered at the lowest possib le cost. This might include delivery of care by a less trained person than heretofore, or by someone with limited but focused training. Shar ing of skills is a more sensible subject for discussion than transfer of tasks. We review a number of studies which show the effectiveness o f inter-professional substitution in various care settings, and also t he effectiveness of substitution by those other than health profession als, The views of users of health services on inter-professional subst itution need to be considered. Health professionals and others need to work together to devise innovative ways of delivering effective healt h care. The legal issues need clarification.