We make recommendations on support, capacity, regulation and public awareness and reiterate (frustrated they need repeating) the lessons we set out over 8 years ago👇. But before any efforts to introduce new roles, national/local bodies should resolve issues with established roles.

Our research suggests that a variety of emerging roles have been introduced before significant issues have been addressed, and a much greater level of resource needs to be dedicated to role design, supervision, management and training if roles are to be successfully integrated

International comparisons need to be treated with caution but doctors + nurses account for smaller proportion of NHS hospital workforce than in most countries, albeit USA has gone much further with e.g. physician associates and advance practice in nursing

The scale of change in some services has been dramatic - the ratio of fully qualified permanent general practitioners (GPs) to other clinicians has fallen from 1:1.1 in September 2015 to around 1:2.6 now. That said, NHS's projections to 2036 suggest a fairly similar balance