Published: 20/03/2003, Volume II3, No. 5847 Page 8

Redesigning job roles will be crucial if the NHS is to meet rising public expectations, the director of the Modernisation Agency has warned.

Speaking to managers at a conference on redesigning NHS service delivery, David Fillingham described many of the current roles in the service as an 'accident of history'.

Mr Fillingham said: 'We have had a lot of success with attracting nurses back into the NHS and creating new packages of employment. But skill mix is vitally important. The job roles have been an accident of history and It is not an effective way of working. Yes it is about more staff - better recruitment and retention - but [skill mix] is a real problem.'

Mr Fillingham said 30-40 per cent of ear, nose and throat referrals could be dealt with by GPs with special interests. Tele-medicine could be used by GPs and nurses to manage 40 per cent of dermatology cases.

He said around 40 per cent of orthopaedic outpatients do not need a clinical opinion.

He admitted that redesign was not always a 'resource-free option' and added it was essential to 'focus on the hopes and dreams' of staff if changing patterns of working was to succeed.

The agency is currently working with universities to measure the impact of modernisation on staff and patients.

Studies of doctors working on the cancer collaborative have revealed they were 'psychologically better off ', he said.

'Expectations are rising more rapidly than the new resources coming in. That makes life difficult.We need to pace the transformation, but I firmly believe that if we use the new investment to redesign then we can increase capacity.'

And he said: 'Being a patient is not the same as being a customer or a consumer. It is more like being a citizen, and if we are going to have a tax-funded, free at the point of delivery NHS we have to stick with that as we are now down the road of greater choice.

'But patients do have a responsibility to think through the implications.'