Final Scope of Practice Review revealed

A landmark scope of practice review has called for sweeping change to the future of healthcare delivery in Australia, recommending an overhaul of workforce design, legislation, and funding.
 
The long-awaited ‘Unleashing the Potential of our Health Workforce’ Review was released on Tuesday, making 18 recommendations it says will better allow healthcare professionals to work to their full potential.
 
‘The Review found that virtually all health professions in the primary care sector, including general practitioners, face some restrictions or barriers to working at full scope of practice that are unrelated to their education (skills and knowledge) and competence,’ it said.
 
The year-long review laid bare several barriers facing healthcare professionals, saying there is limited awareness of health professional scope of practice across the multidisciplinary primary care team.
 
It found that preparation of, and support for, health professionals to practice in primary care is limited, and that funding and payment policy settings restrict scope of practice.
 
But the review’s final report did little to allay the long-held concerns of the RACGP, which has raised significant fears about its creation of task substitution, lack of a risk assessment, and costing and evaluation of direct referrals.
 
In light of the review, the college says Australia must avoid following the United Kingdom’s failing National Health Service at all costs.
 
RACGP President Dr Nicole Higgins is now urging the Federal Government be cautious when considering the review’s findings and their impact on the healthcare system, patients, and GPs.
 
‘What we all need to remember is that this is just a report with recommendations,’ she told newsGP.
 
‘It does not mean that it will be actioned or implemented, and those recommendations that are now in the public domain can be further shaped or not progressed.’
 
Workforce design, development, education and planning
The review’s key recommendation is for the development of a National Skills and Capability Framework and Matrix.
 
It says this will make the skills and capabilities of the primary care workforce ‘explicit and transparent at a national level’ and remove ‘incorrect or unfounded assumptions’.
 
It also recommended improved national-level clarity regarding the scope of practice, and revised accreditation standards incorporating general principles for interprofessional education, professional capabilities for primary care, collaborative practice and Aboriginal and Torres Strait Islander health.
 
Additionally, the review recommends the removal of ‘unnecessary barriers to supervision’ in primary care education and training, including those that restrict cross-professional supervision.
 
But Dr Higgins said the ‘biggest failure’ of the review is its potential to create fragmentation and cost blowout.
 
‘The Scope of Practice Review must reinforce the depth and breadth of scope that the GPs already have and reduce the barriers that prevent GPs from doing their work,’ she said.
 
‘It is reductionist, it focuses on tasks and not outcomes, and it’s those outcomes who are our patients, who are our taxpayers, and who are the GPs and the health workers that operate the system.
 
‘What it means for patients is that their information will be scattered around the health system without one health provider knowing what somebody else has done.’
 
Funding and payment policy
The review proposes the introduction of a new blended payment to enable access to multidisciplinary healthcare delivered by health professionals working to full scope of practice.
 
‘The new payment would be supported by a growth in investment in primary care, shifting the ratio of Australian Government payments for primary care from 90:10 fee-for-service: blended payments to 60:40 over time (at an aggregate national level),’ it said.
 
‘This recommendation addresses and supports the growth of new and innovative primary care models, the sustainability of which have historically been limited due to challenges accessing MBS funding.’
 
It recommends the introduction of a bundled payment for maternity care to enable consistency of funding for midwifery and shared care models.
 
It also recommends the implementation of new direct referral pathways for allied health professionals, midwives, nurse practitioners and remote area nurses to refer to non-GP medical specialists within their scope of practice, and with timely notification to GPs and relevant members of the multidisciplinary care team.
 
‘This recommendation will remove the cost and delay in accessing care when consumers are required to obtain a referral from a GP to see a medical specialist,’ it said.
 
But Dr Higgins has raised significant concerns that Australia is already heading in the direction of the United Kingdom’s failing healthcare system, saying this is being done due to ‘political whims that are not based in evidence’.
 
‘If we’ve got a fragmented health system, it means that GPs and other health providers are working blind because we don’t know what others have done, and this means that those decisions can cause harm,’ she said.
 
‘It puts the patient at increased risk and will cost the taxpayer more through the ordering of more tests, through repeats, without any oversight or coordination.
 
‘We are all trained differently – GPs are trained in undifferentiated illness and uncertainty, we’re taught clinical reasoning over a long period of time, which makes the complex thinking look easy, but when we all work together, we get the best outcome.’
 
Legislation and regulation
The review calls for activity-based regulation of scope of practice to complement the current protection of title approach, as well as a targeted review and harmonisation of priority legislation and regulation.
 
It is also recommended that the regulatory model for professions operating outside of the NRAS be
strengthened and standardised to address specific legislative and regulatory issues.
 
Finally, it calls for the establishment of an Independent Mechanism to provide evidence-based advice to government and key stakeholder groups in relation to emerging health care roles and workforce models that involve a significant change to scope of practice.
 
‘It is expected that the Independent Mechanism will provide a more streamlined pathway into practice for new and innovative models of care and promote consistency across jurisdictions, it said.
 
Enablers for change
The review says Primary Health Networks will hold a central role in supporting the reform agenda and will be ‘given targeted capacity building’.
 
‘To ensure the design and implementation of recommendations is appropriate, fit-for-purpose and sustainable, communications and training, and embedded consumer co-design and consultation will be essential principles of the reform program,’ the review said.
 
Finally, it says a dedicated approach to prioritise implementation of reforms in rural, remote and underserved communities will apply to all relevant recommendations.
 
Health and Aged Care Minister Mark Butler said moving forward, the Government will collaborate with state and territory governments, peak bodies, AHPRA and patient groups to discuss the report’s recommendations.
 
‘This review validates the frustrations of so many of our incredible health professionals: the health system does not enable and support them to consistently deliver the care that is within their skills, training and experience,’ he said.
 
‘Removing these barriers would make it easier for Australians to get high quality health care, when and where they need it, without waiting weeks or driving long distances.’
 
The year-long review included 31 public consultation sessions, 100 sessions for healthcare organisations, and almost 200 written submissions.
 
The Federal Government said it will now ‘carefully consider’ the findings and recommendations.
 
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