Roles of health professionals are still unfortunately often stuck prior to now. That is, before the shift of education of nurses and other health professionals into universities within the Eighties. So many are still not working to their full scope of practice.
There has been some expansion of roles in recent times – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.
But the recently released paper from an independent Commonwealth review on medical experts’ “scope of practice” identifies the myriad of barriers stopping Australians from fully benefiting from health professionals’ skills.
These include workforce design (who does what, where and the way roles interact), laws and regulation (which regularly differs in accordance with jurisdiction), and the way medical experts are funded and paid.
There is not any easy quick fix for any such reform. But we now have a wise pathway to enhance access to care, using all health professionals appropriately.
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A brand new vision for general practice
I recently had a COVID booster. To do that, I logged onto my general practice’s website, answered the query about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for some time, after which went home. Nothing remarkable in any respect about that.
But that interaction required a bunch of facilitating aspects. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The enterprise capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.
The way forward for primary care is one involving more use of the range of health professionals, along with GPs.
It could be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there isn’t a Medicare rebate for this. This arrangement would wish each health professionals to have access to my health record. There also must be trust and good communication between the 2 when the physio might think the GP must be alerted to any issues.
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This vision is one in all integrated primary care, with health professionals working in a team. The nurse should have the option to do greater than vaccination and checking vital signs. Do I actually need to see the GP each time I would like a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.
How about pharmacists?
An integrated future is just not the one future on the table. Pharmacy owners especially have argued that pharmacists should have the option to practise independently of GPs, prescribing a limited range of medicines and shelling out them.
This will inevitably reduce continuity of care and potentially create risks if the GP is just not aware of what other medications a patient is using.
But a greater role for pharmacists has advantages for patients. It is usually easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and that is one in all the explanation why independent pharmacist prescribing is gaining traction.
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Every five years or so the federal government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies can be paid for shelling out medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing could also be a part of the next agreementthe small print of that are currently being negotiated.
GPs don’t like competition from this recent source, although there can be loads of work around for GPs into the foreseeable future. So their organisations highlight the risks of those changesreopening centuries old turf wars dressed up as concerns about safety and risk.
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Who pays for all this?
Funding is at the center of disputes about scope of practice. As with many policy debates, there’s merit on either side.
Clearly the federal government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical advantages payments have to be redesigned and supplemented by payments that allow practices to interact a spread of other health professionals to create health-care teams.
This ought to be the principal direction of primary care reform, and the ultimate report of the scope of practice review should make that clear. It must give attention to the general goal of higher primary care, fairly than simply the aspirations of individual health professionals, and dealing to knowledgeable’s full scope of practice in a team, not knowledgeable silo.
In parallel, governments – state and federal – must ensure all health professionals are used to their better of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate higher access to care from all appropriately qualified health professionals.
In the case of prescribing, it is feasible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements might be that pharmacists can only renew medications in the event that they have agreements with the GP and there’s good communication between them. This could also be easier in rural and suburban areas, where the pharmacists are higher known to the GPs.
The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a wise path to enhance access to care using all health professionals appropriately.
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