Icelandic doctors seek consultation on shifting healthcare tasks

Steinunn Þórðardóttir, chair of the Icelandic Medical Association, says the association is not categorically opposed to transferring duties between healthcare professions, but criticises the lack of consultation with doctors, mbl.is reports.

“We are surprised that we have, in practice, largely been excluded from this discussion,” Steinunn told Morgunblaðið.

She stressed that the association’s criticism was not directed at changing the division of duties itself. There were many examples where she believed all sides agreed, she said.

Steinunn pointed to a working group examining an expanded scope of practice for specialist nurses. No doctor is a member of the group, even though it is considering duties currently performed by doctors.

“Why do people think we should not take part in the discussion about which of our duties should be transferred to others and which should not?” she said.

She made a similar point about work on expanding pharmacists’ role, saying it was important to distinguish opposition to change from criticism of how changes were designed or prepared.

“It is not really the idea itself or the discussion. I think it is entirely legitimate, and of course we should all work towards the same goal: what is best and safest for service users,” she said.

Steinunn rejected the suggestion that the association’s position was driven by fear.

“This is certainly not fear, but caution,” she said.

She wants healthcare professions to form a joint consultation group on the division of duties. The group should discuss the allocation of responsibilities generally, rather than focusing only on transferring doctors’ duties to other professions.

Steinunn also agreed that nurses and midwives should be able to use their own professional licence numbers for tasks they are authorised and qualified to perform. Otherwise, responsibility can become unclear when a task is recorded under the number of a doctor who was not involved.

“What they normally do and are trained to do should of course be their responsibility,” she said of midwives.

However, the Icelandic Medical Association does not support every proposed transfer of duties. Steinunn said doctors would still need to be involved in clinical assessments and decisions in some cases, meaning each task would have to be assessed individually.

Steinunn said changes to the division of duties should be based on evidence and their effects should be evaluated. In some cases, it could be sensible to begin with limited pilot projects before introducing changes more widely.

“So that we can be sure we are ensuring the quality of the service, user safety and efficiency through the change,” she said.

Following the interview, Steinunn sent Morgunblaðið a policy statement from the World Medical Association on the transfer of duties. It emphasises patient safety, clear responsibility and consultation with doctors.