| Summary: | In Norway around 25% of personnel working in the municipal health and care services lack a relevant health-related education (i.e. are unskilled), while at the same time the care need of patients in the community is increasing. We know little about how this affects the quality of services and the safety of patients. In addition, we know little about the consequences of changes in skill mix, e.g. when higher qualified personnel are replaced with personnel with lower qualifications. With skill mix we mean the composition of the various categories of nursing staff providing direct patient care. With the aim to summarise the evidence in the field in a systematic review, we searched for studies that evaluate the effects on quality of care and patient safety of a high proportion of unskilled personnel working directly with patients and the effects of changes in skill mix.1. We found no studies that evaluated the impact on quality of care and patient safety of a high proportion of unskilled personnel working in direct patient care.2. Nor did we find any eligible studies that evaluated the impact on quality of care and patient safety of a change in skill mix. This review highlights the lack of high quality evidence from studies with robust study designs, on this important and current research topic
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