RACGP unveils Scope of Practice Review insights

As the final report into the landmark Scope of Practice Review draws ever closer, the RACGP has publicly released its three submissions into the investigation.
 
The RACGP has long raised ‘deep concerns’ about what will lay within the report, what it will recommend, and what it will mean for the future of general practice.
 
College President Dr Nicole Higgins said thinking about its contents has ‘kept me awake at night’, and after years of consultation, that final report is now imminent.
 
It remains unclear exactly when the final Scope of Practice Review will be handed down and whether it will be made public, but in the wake of its near completion the RACGP has, for the first time, released its three submissions to the three rounds of consultation.
 
These have not been released previously ‘for strategic reasons’, according to the RACGP.
 
The RACGP’s submissions highlight how GPs can benefit patients if the profession’s scope of practice is increased, as well as its concerns over a devaluing of GPs’ specialised training.
 
They detail how the review must be about more than task substitution, point to a lack of a risk assessment, costing and evaluation of direct referrals, and warn that Australia is following the path of the United Kingdom’s failing National Health Service.
 
Throughout the lengthy review process, the RACGP has consulted widely with members via webinars, conference workshops, member consultation webpages and by directly consulting RACGP Faculty Councils, RACGP Expert Committees, censors, medical education and workforce teams.
 
Dr Higgins urged members to remember that the review can only make recommendations, and that the plans it puts forward can only be accepted by the Federal Government before they are enacted or implemented.
 
‘We’ve seen this Review try to reduce medicine and healthcare to tasks and activities, when really it needs to be looking at outcomes and how they can be achieved,’ she told newsGP.

‘There are now widespread fears among our GPs these scope changes will lead to a healthcare system that is fractured and broken, where patients cannot access or afford the critical care they need and deserve.
 
‘We’ve have been advocating tirelessly for more than a year on behalf of the 50,000 GPs who stand to have their professions changed by this review and if our concerns are not met, the Federal Government will have the RACGP and those 50,000 GPs knocking at its door.’
 
RACGP submission one: 11 September – 16 October 2023
This was the RACGP’s first submission into the Scope of Practice Review consultation.
 
It came after the review specifically asked for the experiences, views and perspectives of health practitioners working to full scope of practice in primary care.
 
The RACGP embarked on a wide-ranging consultation effort to gather the insights and experiences of its members, and overwhelmingly, the majority felt they could increase their scope of practice for the benefit of their patients.
 
The college also emphasised that the review must be about more than task substitution and pushed for consideration of GP views.
 
‘Primary care is about more than just the setting or being an access point for the system,’ the submission said.
 
‘By adopting a patient-focused model of care, it supports GPs working to their full scope of practice to provide continuous and coordinated care to patients of all ages, genders and cultural backgrounds.
 
‘In delivering a high-performance health system, it is necessary to allocate resources carefully and effectively and assess the cost-effectiveness of services.’
 
RACGP submission two: 25 February – 8 March 2024
The second submission focussed on the release of Issues Paper 1 which collated findings, themes and observations from the literature review, submissions, conversations, surveys and forums.
 
Following feedback from its members, the RACGP’s submission expressed concerns about the ‘disproportionate emphasis’ on the oversimplification of general practice and the role of the generalist.
 
‘The perceived devaluing of the specialised training required for general practice will impact on morale and GP workforce attraction and retention,’ the second submission said.
 
‘The RACGP does not support a capitation model and we caution the reviewers against funding models that do not align with the flexibility required in general practice.’
 
It also said there is a ‘serious likelihood’ of wasted financial resources and the perceived devaluing of the specialised training required for general practice.
 
RACGP submission three: 16 April – 26 May 2024
The research of the Scope of Practice Review’s Issues Paper 2 brought with it a new wave of concern from GPs, leading Dr Higgins to label it ‘McMedicine’.
 
It proposed eight policy reform options across three key themes – workforce design, development and planning, legislation and regulation, and funding and payment policy.
 
It said that doctors’ skills are currently poorly recognised, there is a lack of exposure to primary care for medical students, and legislation is impeding doctors working to their full scope.
 
It also noted several barriers and their tangible impacts, including reduced skills portability, poor workforce retention, inadequate patient access to care in regional areas, high GP workloads, and reduced opportunity for multidisciplinary care.
 
The RACGP’s submission reiterated concerns that GPs were being undervalued, and that scope of practice discussions must remain connected to general practice multidisciplinary team-based settings that promote comprehensive and collaborative care.
 
‘The review frames healthcare as a commodity and regulation as a perceived barrier to the consumer obtaining their desired product. This simplistic framing misunderstands the principles of good primary care,’ it said.
 
‘The RACGP holds strong concerns that the scale of evidence used as a base for the review is heavily skewed in favour of non-medical models of care.
 
‘The underlying bias in the evidence used bears itself in the tone, perspectives, and focus of the review.’
 
RACGP submission four: 3 – 17 September 2024
The final stage of consultation on the Scope of Practice Review is ‘targeted and confidential’ and was designed to allow invited stakeholders to highlight factual inaccuracies within the draft final report.
 
This consultation was not made public by the Federal Government.
 
Now in its fourth and final stage of consultation, the Review’s findings, recommendations and an implementation plan are expected to be handed to the Commonwealth next month.
 
A Scope of Practice Advocacy webpage has also been created to keep members updated on RACGP’s advocacy on the subject.
 
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