At the 30th WONCA Europe Conference 2026, the question of delegating certain general practice activities to other healthcare professionals sparked a widely followed debate that revealed two opposing visions for the future of primary care.

The room was packed to hear this exchange between two leading figures in European general practice: Nicolas Sen, MD, PhD, a family physician and director of the Department of Family Medicine at the University of Lausanne, Lausanne, Switzerland, who supports a shift toward interprofessional teams, and Peter Holden, vice president of the European Union of General Practitioners, and a senior official at the British Medical Association, a staunch defender of the central role of the general practitioner. 

‘Do We Really Have a Choice?’

For Nicolas Sen, the issue is not simply a matter of delegating tasks. It requires a profound transformation of how care is organized.

“The future lies in interprofessional collaboration and teamwork. It’s not just about delegating, but about redefining our identity, our role, and the way we work,” he explained.

In his view, general practitioners must refocus on what constitutes the core of their profession: making a diagnosis, understanding the patient’s overall situation, and proposing the best treatment strategy. Other tasks, such as therapeutic education, certain preventive activities, or the organization of care, can be handled by other healthcare professionals.

The Swiss professor draws on the scientific literature, which he says shows that multidisciplinary teams improve the patient experience, the well-being of caregivers, and various care processes. Given the declining number of general practitioners observed in many countries, this shift seems inevitable to him.

“If we don’t build these teams ourselves, delegation will be imposed on us. And if we resist, the only delegation left to us will be to AI,” he continued.

Patient Safety Above All

Holden agrees that there are pressures on primary care but rejects the idea that general practice can be delegated in its entirety.

For the British physician, it is first necessary to distinguish between the delegation of certain clearly defined tasks and the replacement of the general practitioner.

“General practice is not a technical exercise. It involves the complex management of multiple risks based on information that is often incomplete. These skills are unique to the physician,” he argued.

The British representative was particularly critical of developments in the UK, where certain primary care procedures are now entrusted to physician assistants or other healthcare professionals. In his view, this policy — driven primarily by budgetary considerations and concerns about access to care — has already led to several serious diagnostic errors and preventable deaths.

On the other hand, he acknowledged that certain standardized procedures — such as monitoring patients with diabetes or high blood pressure, administering vaccinations, or conducting certain follow-up visits — can be entrusted to specially trained nurses, provided they remain under the responsibility of the general practitioner.

Shared Care Rather Than Delegation?

Discussions with the audience quickly revealed that the debate went far beyond a simple “for” vs “against” dichotomy.

Several speakers emphasized that the real issue lay less in delegation itself than in how it is organized: clarification of responsibilities, communication among professionals, team governance, and information sharing.

French physicians, in particular, pointed out that certain tasks are already widely delegated — such as vaccinations or certain preventive measures — but often without real coordination, which leads to wasted time and difficulties in monitoring patients.

Other participants preferred to speak of “shared care” rather than delegation, believing that each professional should contribute their specific expertise within an organized team, rather than replacing the physician.

The Growing Role of Pharmacists Is Also Raising Concerns

The debate eventually broadened to include the expansion of pharmacists’ scope of practice, particularly in Australia and the UK, where they are now more involved in prescribing and certain forms of patient care.

Holden expressed significant reservations about this trend, arguing that while pharmacists possess essential expertise in medication, they should not be responsible for the initial diagnosis of patients presenting with undifferentiated symptoms.

In his view, political pressure to rapidly improve access to care sometimes leads to prioritizing organizational solutions at the expense of patient safety.

An Issue That Transcends Borders

Beyond the differences of opinion, there was consensus on one point: Primary care will have to evolve to address the shortage of physicians and the aging population.

But how far can this evolution go without undermining the role of the general practitioner? Should we speak of delegation, cooperation, or shared care? Behind these terms lies a more fundamental question for the future of family medicine in Europe: How can responsibilities be better distributed while ensuring the quality, continuity, and safety of care?

This story was translated from MediQuality, part of the Medscape Professional Network.