The iMpact on practice, oUtcomes and costs of New ROles for health care professionalS: results from the MUNROS study

Talk Code: 

The problem

European countries are reforming their health systems to optimise the outcomes of care as cost effectively as possible. One way they are doing this is by changing skill mix within health care teams: extending the roles of existing professions and introducing new ones. MUNROS is an FP7 project exploring these changes across nine European countries (Scotland, England, Norway, Netherlands, Germany, Italy, Poland, Czech Republic and Turkey), in primary and secondary care, focussed on breast cancer, type-2-diabetes, and heart disease. Early case studies suggest that all participating countries are engaging in role diversification, but the underpinning detail is variable. The aim of the current phase of the project is to use questionnaire surveys to describe the nature, scope and contribution of the new professional roles, and evaluate their impact on clinical practice and integration of care. In later stages clinical outcomes and productivity data will be collected.

The approach

In each partner country the study sample will be based on a purposive sample of 12 hospitals, and 60 general practices. The health care professionals and managers involved in delivering care in the three target conditions will be identified and sent a questionnaire which will collect data to describe who does what at all stages of the care pathway. It will detail current roles, skills and competences as well as identifying the drivers of skill mix change, and effects on integration of care. In primary care the target sample per country is 180 GPs, 360 other health care professionals and 180 managers. Patients with each condition will also be asked to complete a questionnaire. The items will describe experience of and satisfaction with care, the value placed on that care, health care utilisation costs, medical history and basic socio-demographic information. In primary care six patients per condition per practice (total 1080), randomly selected from surgery lists, will be mailed a questionnaire invitation pack. Up to two reminders will be sent. The project has received ethical approval, a pilot study has been completed, questionnaires have been finalised, and will be distributed in early March.The findings The survey is just starting and no results are currently available. Results from primary care in England and Scotland will be presented at the meeting. A cross-country comparison will be made where results are available from other countries. The substantial challenges and risks of co-ordinating a survey of this scope across Europe will also be discussed.The consequences The ultimate aim of the project is to conduct an economic evaluation to identify the cost effectiveness of the new professional roles, identify optimal models for delivery of health care, and design a multidisciplinary workforce planning tool based on competences needed to deliver care, and population need.


  • Christine Bond, University of Manchester, Manchester, UK
  • Robert Elliott, University of Manchester, Manchester, UK
  • Hanne Bruhn, University of Manchester, Manchester, UK
  • Matthew Sutton
  • Jonathan Gibson