The recent decision by the British Medical Association to drop its long-standing opposition to nurses taking over doctors' role as patients'
first contact point in the health service has wider significance. It is the latest sign of radical change in Britain's public services.
Public-service professionals are having to re-evaluate how they work as recruitment problems, rising expectations and insufficient resources make existing practices unsustainable.
In education, the symptoms are well-documented. Teacher shortages and workload have stumped ministers so far.
Joseph Heller would have appreciated the problem facing the Government, a classic catch-22 situation. A recent TES teachers' survey of teachers showed workload not pay is most likely to force them out of the profession. But more teachers are needed to cut workload.
Much of the extra money put into schools by Labour since 1997 has been used to create teaching posts which heads then cannot fill adequately.
Education Secretary Estelle Morris admitted last year in a speech to the Social Market Foundation think-tank that there could be a shortfall of 30,000 teachers by 2006 - and it will be even worse if the Government fails to recruit 10,000 extra teachers.
At the same time, she put forward a plan to change radically the way schools work, which she hopes could help solve the problem. She wants schools to become more like hospitals, with an army of para-professionals taking over many of the jobs currently done by teachers. Official figures show that the number of support staff in schools has already risen from 113,191 in 1997 to 157,181 last year, with teaching assistants accounting for 34,000 of the 44,000 increase. And if Ms Morris gets her way, this trend will accelerate.
She is set to announce 30 pilot projects in schools to find out how teaching assistants, bursars, administrative support staff and technicians could be employed to ease the burden on teachers.
As one senior civil servant said: "When heads have a vacancy they should consider whether it would make more sense to employ two classroom assistants rather than one teacher."
However, good policy on paper may not translate into good practice. Many newly-qualified teachers complain that they are not properly prepared to manage a more experienced member of staff when they begin work in schools.
There is also confusion over what exactly teaching assistants will be expected to contribute. Ms Morris's suggestion that they could take classes in teachers' absence provoked an outcry from the teaching unions.
But the traditional role of a parent-helper who cleans the paint pots and takes little Johnny to the toilet, while still true for a small minority, is now hopelessly out of date.
According to Roger Hancock and Will Swann of the Open University, who carried out a recent study for the European Social Research Council, many assistants are already acting as "partial teachers".
The evidence is compelling. For instance, 84 per cent of teachers said assistants regularly contributed to the assessment of children's progress, and 76 per cent said assistants were regularly involved in recording children's work."
Assistants were also working with groups of all sizes - sometimes up to 10 children. And one in five assistants sometimes worked with the whole class on their own. Assistants often worked away from teachers with varying degrees of independence - 91 per cent said they sometimes withdrew children from classrooms.
But the study's authors acknowledge that many assistants could find the transition to taking whole classes difficult. Research studies have shown that only a minority of assistants want to become teachers.
However, that does not mean they are happy with their lot. There is currently little official recognition of the wide range of responsibilities that assistants take on. Most earn pound;5-pound;6 per hour and, according to the Government's own research, experience and training is rarely reflected in pay.
Public-sector union Unison represents the largest number of teaching assistants. The union estimates that 70 per cent of schools have no formal procedures for monitoring their training and development. Three-quarters feel that they are not well-paid, and almost half get no holiday pay.
Unison says for the plan to work, teaching assistants need a proper national career structure while formal recognition of their skills and experience would boost their status.
Discussions are under way with local education authorities, represented by the Employers' Organisation. And although Unison describes the progress so far as slow, Graham Lane, chair of the Employers' Organisation, says that he is keen to reach an agreement which allows local flexibility but ensures people doing the same job in different parts of the country are not paid widely differing salaries.
"Why should assistants in Camden earn about pound;9 per hour when those in Newham earn about pound;5 for doing the same job?" he asked. "We need a proper national framework which allows assistants access to training and promotion."
He says that those who become heavily involved in the teaching of pupils should be properly rewarded and estimates that pound;500 million is needed to start a national framework. Although those with little experience or responsibility would continue to earn pound;5,000-pound;8,000 per year pro rata, he believes experienced classroom assistants should earn pound;20-25,000 - more than newly-qualified teachers.
"It is implicit in Estelle Morris's plans. If people are really getting trained and experienced in what is effectively teaching individuals and groups of pupils, often with special needs, you would expect in the end that they would see their salary rise to the bottom end of the scale for professional teachers," he said.
A local agreement made by employers in Nottinghamshire earlier this year means that a few classroom assistants may earn more than NQTs within a few years.
But across the country the idea that support staff could earn more than a teacher would represent a radical shift in the classroom culture, and many in the profession could be angered by this apparent undermining of their status.
The unions currently look set to oppose anything which smacks of replacing teachers "on the cheap" or which undermines their classroom authority.
John Bangs, head of education at the National Union of Teachers, described the idea that teaching assistants could earn more than NQTs as a "red herring". He said it would increase anxiety among teachers that little would be done to improve their contacts.
A government working party, including representatives of the teaching unions and Unison, is currently looking at ways to "remodel" the teaching profession.
Unions will have to respond to the Government's proposals for three different tiers of assistant, each with varying degree of skills, responsibility (and presumably pay) by mid-April. At the moment an increase in the role and status of other staff in school is the only serious solution to the workload problems that has ministerial and local government backing.
For more than half a century, doctors jealously guarded their role as gatekeepers of the NHS. Now schools may have to decide whether teachers should follow suit.