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‘Devalued’ GPs rail against task substitution in Scope review
The role of general practice is oversimplified and the profession misunderstood, according to a scathing RACGP Scope of Practice submission.
The RACGP has warned a lack of focus on continuity of care will only weaken Australia’s healthcare foundations.
The RACGP has unleashed a long list of fears, frustrations, and fury about the future direction of Australian healthcare, warning there will be ‘costly outcomes’ for patients, budgets, and the health system if continuity of care is not prioritised.
In response to the second round of consultation for the Commonwealth’s Scope of Practice Review, the college voiced strong objections to the shape the report is taking, saying its purpose must go beyond simple task substitution.
It also reiterated that primary care is much more than an initial entry point, and said the current review places a disproportionate emphasis on first contact access and an oversimplification of general practice.
‘There is a serious likelihood of wasted financial resources and recommendations that will have very costly outcomes for patients, the health system and the health budget,’ the submission states.
‘More specifically for GPs, the perceived devaluing of the specialised training required for general practice will impact on morale and GP workforce attraction and retention.’
According to the college, the review has likewise overlooked evidence related to the benefits of continuous and coordinated care, raising significant concerns that general practice is being viewed as a barrier rather than a solution.
RACGP President Dr Nicole Higgins said the submission reflects a feeling of anger among many of the college’s 40,000 GPs over the current state of healthcare and the reputation of the profession.
‘The work and the role of GPs has been devalued down to tasks, and it feels like everyone wants to become a doctor without going through the rigours of medical school,’ she told newsGP.
‘GPs’ medical training differs from nursing and pharmacy training, so we’re trained to work differently and while sometimes we might have shared tasks, we approach them differently.
‘GPs have been taught clinical reasoning and critical thinking and, yes, we have some shared tasks, but whole people don’t come in bits that can be picked off as a task.’
With all areas of the healthcare workforce struggling for numbers, the review was a priority recommendation of the Strengthening Medicare Taskforce Report, aimed at allowing health professionals to work to their full potential, while emphasising the need for multidisciplinary teams.
Its initial Issues Paper, released earlier this year, also clearly expressed the need for a different funding model and better coordination between specialties.
But Dr Higgins said the current societal views of GPs are ‘devaluing who we are and what we do’, and it is having detrimental impacts on professional morale.
‘We’re fighting for the future of general practice,’ she said.
‘When we’re trying to encourage medical students to become GPs, the message that’s being sent by governments to our young doctors is working against us.
‘I want to assure members that there is a lot of work happening in the background to make sure that general practice and our profession is valued.’
While acknowledging that Australia already has one of the top health systems in the world, the RACGP submission outlines several reform priority areas which would allow GPs and practice teams to work to the top of their scope.
First, it says pharmacy location and ownership rules must be reviewed to allow dispensaries within general practice, and that GPs should be allowed to dispense medication.
Second, it recommends that ‘artificial restrictions’ placed on MBS item descriptors and PBS restrictions must be removed, as they ‘unnecessarily curtail’ GPs.
Its other key reform recommendations include:
- harmonising legislation across jurisdictions to reduce administrative burden and streamline processes
- recognising GPs as specialists with agencies such as Centrelink, workers compensation bodies, the Department of Veterans’ Affairs, and the National Disability Insurance Agency
- enabling broader general practice teams to deliver more independent practice
- recognising GPs’ advanced skills through structured training
- exploring innovative models of employment to increase the GP workforce
- increasing funding to support interdisciplinary and multidisciplinary care
- improving the user experience of current ‘clunky’ electronic medical record software.
The consultation paper also warns about the Review’s current investigation into health systems in the UK and Canada, saying they could be a ‘cautionary tale’.
It warns they are all facing their own GP workforce crises, despite a decade of attempting role or task substitution through nurse and pharmacist prescribing.
Last year,
a UK Pulse survey revealed 45% of full-time GPs aged 30–50 years old were considering reducing their hours.
A
second survey found that 21% of UK doctors who had indicated they were likely to leave the profession had contacted a recruiter, while 14% had applied for a role abroad – with Australia being the preferred destination.
‘Our health system is in the top three in the world, and we will not let this become a basket case,’ Dr Higgins said.
‘The NHS has not only created GP refugees, but also now health refugees as people from the UK flee their health system.’
The review’s final report and implementation plan is due to be handed to the Department of Health and Aged Care in October.
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