Structural redundancy is avoided by directly placing the AGnES employees in the general practitioners' practices. Based on the results of the AGnES projects, the law in Germany has now been amended to enable implementation of the AGnES project in the regular health care system from January 2009 onward. The next steps to be taken are the establishment of adequate reimbursement within the catalog of the statutory health insurance scheme and a detailed definition of the required qualifications.
The qualification is a promising approach to compensate for the imminent under-supply of primary care and allows maintenance a high standard of healthcare quality for rural areas of Germany and countries with similar structures. It supports doctors through task delegation, and offers an option for an advanced training for nurses.
Germany is at the beginning of the process of the future task sharing between nurses and physicians. The realization requires a comprehensive political support and further development of concepts including scientific implementation and evaluation.
Demographic trends and expected changes regarding future health care require substantial structural reforms of the German health care system. It is generally assumed that nursing education and training as well as curriculum development and also the competencies of professional nurses must adapt to the changing demands of health care supply. Moreover, the expected shortage of general practitioners demands solutions for easing their growing workload, which will include the assignment of certain services to health care professionals which perform these services autonomously or in behalf of the practitioner. Consequently, nurses have to expand their scope of skills and expertise. In order to prepare nurses for their new and extended roles, different curricula for professional and academic educational programmes are currently developed. If nurses are to perform additional tasks, it is essential to delegate some of their regular duties to health care assistants. Consequently the latter must be included in the reform process since their current range of duties will be modified as well.
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