RACGP welcomes ‘bold’ first look at Scope of Practice reforms

The creation of a health system focused on multidisciplinary care and appropriate funding would benefit patients and GPs alike, according to a new paper.
 
The call comes as part of a Commonwealth investigation into Unleashing the Potential of our Health Workforce, designed to ensure Australia is optimising the skills and training of its medical professionals.
 
An initial Issues Paper was released on Thursday, collating information from submissions, literature reviews, and consultations, and naming up several interconnected themes impacting medical professionals.
 
The paper said a ‘highly functional, collaborative interprofessional team provides an array of benefits to the system, health professionals and consumers’, with many respondents identifying a need for multidisciplinary care across professions.
 
‘Consultation respondents were broadly divided along professional lines about whether non-medical professionals working to full scope of practice would offer benefits compared with the existing GP-centred primary healthcare model,’ it added.
 
RACGP Vice President Associate Professor Michael Clements told newsGP he is pleased to see acknowledgment of the need for greater coordination, and a team-based approach with GPs at its core.
 
‘I do remote clinics, I go to different places and when we’ve got people seeing different healthcare providers with a disconnected medical information system, disconnected medical records, no clear communication pathways or teamwork, people actually get worse outcomes because we’re just not sure what’s going on,’ he said.
 
‘I liked that the document was bold in talking about different funding models and that it acknowledges that the system that we’ve got now is largely a reflection of the funding system.
 
‘I think this document appropriately acknowledges that there’s different funding models, there’s fee-for-service payments, but I think it quite appropriately says that we do have to look at things like scope of practice at the same time that we look at funding models as a way of generating change.’
 
The paper found that access to funding for treatment influences health professionals’ ability to perform at their full scope of practice, and said broader funding models can reward procedural care over preventive and comprehensive, team-based care.
 
It also laid bare concerns primary healthcare workers would leave the profession if lower reimbursement rates do not improve.
 
Associate Professor Clements said GPs are managing increasingly complex and advanced diseases, creating an urgent need for a funding overhaul.
 
‘We don’t want tinkering around the edges, we don’t want a new Medicare item number, we don’t want a new single incentive payment,’ he said.
 
‘We need to recognise that the work can be harder for GPs with longer consults, and we need to make sure that the remuneration systems reflect that kind of work.
 
‘We have been short-staffed for a long time, we have been reliant on small numbers of people, we’ve had limited funding, and we just get on with the job.’
 
The authors added that non-medical professionals could begin to make referrals by reviewing MBS payment rules, saying this may help combat an overreliance on GPs to manage all referrals.
 
There were also respondents calling for legislation to be streamlined among the states and territories, but Associate Professor Clements described this plan as a ‘first step’.
 
‘Then we need to look at how can we harmonise the funding so we can get state, federal, and even in some cases local council, contributions to the outcomes,’ he said.
 
‘A lot of what they’re seeking to do here, in terms of using all the skills, using the best skills of everybody for the best betterment of the community, is what we have been doing in the remote communities.
 
‘When they are looking at this scope of practice and when they are looking at these reforms, I think they just should start looking at some of the country models of care, some of the rural towns where we have been doing well.’
 
However, the paper said whatever changes are to be made in the future, there are risks if quality and safety of care is not maintained throughout.
 
It suggested the need for a small-scale trial of reforms and strong ongoing research and evaluation mechanisms.
 
Ultimately, Associate Professor Clements said GPs’ scope of practice is already fluid as they adjust to their patients’ changing needs.
 
‘We do react and adjust to our community needs, we react and adjust to our own personal needs and interests, and then we follow them,’ he said.
 
‘I don’t think you could ever define what a GP scope of practice is because we are one of the only professions that are allowed to, and do, learn on the job, and learn what we need to.
 
‘My personal scope of practice five years ago is different to now because it’s not that I’ve got a bigger scope of practice, I’ve just moved my scope of practice to what my community needs.’

The review was a priority recommendation of the Strengthening Medicare Taskforce Report, and will focus on GPs, nurses, pharmacists, midwives, allied health practitioners, Aboriginal and Torres Strait Islander health practitioners, and paramedics.
 
In conclusion, the paper said health professionals working to full scope of practice ‘reduces workload for the acute care sector, increases health professional utilisation and retention and creates efficiencies at a system level’.
 
‘Many consultation respondents agreed with the benefits identified in the literature; that a highly functional, collaborative interprofessional team provides an array of benefits to the system, health professionals and consumers,’ it stated.
 
Public submissions to the review are open until 8 March, before a second issues paper is released in April.
 
A final report and implementation plan is due to be handed to the Department of Health and Aged Care in October.
 
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general practice scope of practice