Government urged to learn from NHS failures

RACGP members are ‘very concerned’ about the Federal Government’s ongoing Scope of Practice review, President Dr Nicole Higgins has said.
 
Led by Professor Mark Cormack, the review has so far received nearly 1000 submissions and been informed by a series of national consultation sessions aimed at ‘unleashing the potential’ of Australia’s healthcare workforce.
 
While the review’s second issues paper has not yet been released, members and RACGP representatives are becoming increasingly concerned about the potential direction it may take, with fears emerging over role substitution and its potential to fragment care.
 
The college’s most recent submission, developed in response to the review’s first issues paper, said it has so far had a ‘disproportionate emphasis’ on first contact access, and oversimplified general practice and the role of GPs.
 
‘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,’ it 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.’
 
The submission also references previous healthcare reforms in Canada and the UK that granted greater autonomy to non-doctor healthcare workers, such as pharmacists and physician assistants, using them as examples of ‘what not to do’.
 
These fears appear to have been picked up by GPs, with 85% of respondents to a recent newsGP poll saying that they are worried about the review’s direction.
 
‘Our members are very concerned the current review appears to be giving serious consideration to a model of care that would reproduce the failures of the UK health system,’ Dr Higgins said.
 
‘Rather than investing in general practice, the UK model fragmented the system, pushing the work of GPs onto health professionals without medical training. They prioritised convenience and focused on single diseases, instead of the whole person.
 
‘This is not an efficient use of a health workforce and limited health resources.’
 
To support her position, Dr Higgins cited reports that lesser-trained UK health professionals have been missing life-threatening diagnoses, as well as a paper from public health thinktank The King’s Fund, which described the lack of primary care investment as one of the NHS’s most significant and long-running policy failures.
 
‘It has been frankly disastrous, with worse health outcomes, unhappy patients, and GPs fleeing – the number of UK-trained doctors in Australia increased a staggering 67% from 2013 to 2021,’ she said.
 
‘[The King’s Fund report] also said the way their health workforce is trained and organised doesn’t meet the complexity of people’s health needs in the UK. We mustn’t make the same mistakes here.
 
‘Australia’s politicians must recognise and invest in the role of GPs at the heart of primary care – GPs keep Australians, and our health system healthy. Everyone’s primary care team needs a GP, and any health reforms must support this.’
 
With the second issues paper due for release this month, the RACGP President said the message from GPs at Australia’s healthcare coalface is clear – strengthen general practice to save the profession and help patients.
 
‘This is significant reform and it’s critical that government hears GPs and gets it right for Australians,’ she said.
 
‘We’re advocating strongly to explain the role of GPs at the heart of primary care. Not everyone understands what we do, but the value of GPs is clear – the evidence shows GPs help people live healthier and stay out of hospital.
 
‘The best quality and value primary care for patients, the health system, and taxpayers is multidisciplinary team care with GPs at the heart.
 
‘General practices already do this every day. We work with nurses, other specialists, allied health, and pharmacists to ensure our patients get the best health outcomes, while making the best use of limited health resources.’
 
Rather than attempting to upskill non-clinicians to undertake the work of a doctor, Dr Higgins believes GPs – who undertake the same first eight years of medical training as other specialists – are already prepared and able to do more, such as interpret ECGs.
 
‘This review must recognise that supporting Australia’s GPs and general practice teams to do more can improve access to care and reduce costs,’ she said.
 
‘We’ve made a range of recommendations to this end, such as supporting GPs to prescribe more medicines, including for acne treatment, and provide more services to patients, like iron infusions, and diagnosis and management of dementia.
 
‘We shouldn’t trade off quality and safety for convenience.
 
‘Australia is in the top three health systems in the world. Let’s keep it that way by investing in general practice care.’
 
Log in below to join the conversation.

NHS scope of practice