PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

8 Acting early on NCDs The Partnership for Health System Sustainability and Resilience■ Create financing mechanisms that reward coordination: Move from fragmented funding streams to population-based or bundled payments that encourage collaboration across providers. Explicitly recognise prevention and coordination activities in payment systems rather than expecting them as unfunded additions to clinical work, ensuring these essential functions are properly resourced. ■ Reform payment systems to align with chronic disease needs: Transition primary care from fee-for- service toward capitation-based models providing predictable funding for prevention and chronic disease management. Where pay-for-performance is considered, careful design is essential to avoid unintended consequences. Priority should go to removing perverse incentives in current systems, ensuring adequate reimbursement for consultation time and team-based care. Workforce capacity CURRENT LANDSCAPE: Some countries are taking bold action: Poland increased medical school admissions limits by 92.3%, and Germany has expanded the role of medical assistant for greater task-shifting. Yet workforce composition remains poorly matched to NCD needs. Primary care faces critical shortages with only 6% of Greek physicians in general practice versus and EU average of 21%. Geographic maldistribution leaves rural areas systematically underserved across all countries. Ageing workforces compound challenges, with Polish physicians averaging over 50 years of age. Task-shifting initiatives show promise but remain limited by regulatory barriers and professional resistance. RECOMMENDATIONS: ■ Develop comprehensive workforce planning linked to NCD projections: Create long-term strategies genuinely reflecting future population health needs rather than perpetuating historical patterns. Model demographic transitions and disease trends whilst considering how new care models and prevention investments might affect workforce demands. Integrate planning across all health professions with continuous monitoring of alignment with evolving needs. ■ Address geographic and specialty maldistribution comprehensively: Create compelling reasons for practice in underserved areas through combinations of financial incentives, career development opportunities, and infrastructure support that makes rural practice genuinely attractive. This might include service obligations for publicly-funded education, rotational models maintaining urban connections, or regulatory approaches limiting further concentration in oversupplied areas. ■ Expand professional roles to optimise skill-mix: Enable all health professions to work at full scope of practice whilst creating new roles specifically designed for chronic disease prevention and management. For example, pharmacists and nurses could manage stable chronic conditions within appropriate frameworks, but this requires aligned regulatory, legal, and payment systems that support rather than obstruct such practice changes. ■ Reform professional education with mandatory NCD competencies: Shift from traditional acute care focus to prepare graduates for chronic disease management reality. Embed prevention, behaviour change, and multimorbidity management throughout curricula whilst ensuring interprofessional education teaches collaborative practice. Digital health capabilities should become core competencies with continuous professional development maintaining currency. ■ Create sustainable careers in prevention and primary care: Address the persistent shortage of primary care and prevention specialists by tackling income disparities with specialists whilst providing intellectual stimulation through research opportunities and academic positions. Reduce administrative burden through infrastructure support and ensure prevention activities are properly resourced within job plans rather than squeezed into overwhelming workloads.