EMO Task Shift - AEMH

EUROPEAN DEFINITION OF THE MEDICAL ACT UEMS 2009 / 14“The medical act encompasses all the professional actions, e.g. scientific,teaching, training and educational, organisational, clinical and medicotechnicalsteps, performed to promote health and functioning, preventdiseases, provide diagnostic or therapeutic and rehabilitative care topatients, individuals, groups or communities in the framework of the respect ofethical and deontological values. It is the responsibility of, and must always beperformed by a registered medical doctor/physician or under his or her directsupervision and/or prescription.”CPME Policy on Task ShiftingCPME/AD/Brd/27112010/128_Final/ENIn October 2009, the WMA defined task shifting as a situation in which a tasknormally performed by a physician is transferred to another health care professional witha different or lower level of education or training, or to a person with specializededucation to perform a limited task only, without having a formal health education (CPMEInfo 203-2009).The CPME is particularly concerned about the fact that task shifting is often initiated byhealth authorities, without consultation with physicians and their professionalrepresentative associations.The CPME wants to emphasize that patient safety, quality and continuity of care should bethe underlying objective of organisation and reforms of healthcare. Therefore, taskshifting, if decided by health authorities, should only be through consultation and inaccordance with the medical profession and not solely as a cost saving measure.As the WMA resolution points out, task shifting may carry significant risks, e.g. decreasedquality of patient care, fragmented and inefficient service, lack of proper follow-up,incorrect diagnosis and treatment and inability to deal with complications.However, used correctly, the shift of some tasks may enable better use of manpowerand resources, free valuable time for physicians and therefore contribute to better carefor patients. In order to guarantee the safety of patients, this should always take placeunder the condition that the responsibility for diagnosis and therapeutic decisions cannotbe divided and remains with a doctor, even if (s)he has shifted a task as described above.The CPME strongly believes that task shifting should not be confused with or replaceinteractive team work and cooperation between doctors and other health professionalslike nurses, physiotherapists, etc. who all make their unique contribution to the best careof the patient.

1Such team work is to be coordinated by a physician since (s)he bears the responsibilityfor diagnostic and therapeutic decisions.Finally, the CPME recognises that task shifting, even to less qualified workers, may benecessary in emergency situations and in countries facing extreme shortage of physicianswhere the only alternative would be no care at all. Even then, however, task shifting canonly be a short term solution, and it is therefore crucial that measures are introduced torelieve these shortages. In some countries and regions, telemedicine could contribute torelieving the problem of physician shortage and, thus, secure that the responsibility forpatient care remains with the physician.Statement on TASK SHIFTING AEMH 10-047Task shifting is a process of delegation whereby physician’s tasks are moved to other healthworkers with the aim to: obtain benefit for the patients; sustaining the quality of the medical process; enable more efficient use of the human resources currently available; rationalizing costs in certain circumstances (successful implementation might require newand additional resources); increase levels of responsibility throughout the health care workforce - additionalresponsibility must go along with increased pay and resources to be found for salary rises; improve job satisfaction.Task shifting could relate to: nurses - expanding services and improving clinical outcomes for patients; pharmacists; administrative personnel (statistical documentation, reports); other health professionals.Prerequisite standards: diagnosis and therapeutic decision must remain the responsibility of the physicians; involving professional representative medical associations before initiating the process bypolitical decision; appropriate health legislation and administrative regulation for task-shifting practice; it should not and must not be associated with second-rate services; it should be a way to improving the overall quality of health services – not only cuttingcosts; ensuring that existing health workers are appropriately qualified for the new tasks theywill be asked to undertake:o training and experience;o examination and mentoring procedures;o opportunities for continuing education.

2EANA position on prescribing of medicationEANA note an increasing trend towards the prescribing of medication by non medical healthcare personnel throughout EuropeEANA further note the trend towards task shifting and cost reduction in health care.EANA acknowledge the progress and benefits of pharmaceutical medicine to patients.EANA affirm our position that the prescribing of medicines and tests must be preceded bypatient history, examination and diagnosis by a physician and that that prescription requiresongoing review based on disease progression and prescription efficacy.EANA have concerns regarding trends towards consumerism in health care. We do notconsider this to be in the best long term interest of patient care.EANA uphold the principles of patient (doctor) preference and continuity of care, and confirmour commitment to Continuous medical education/Continuous professional development(CME/CPD).