A policy maker, a GP and a pharmacist walk into a bar

A surprising amount of collegiality emerges between key stakeholders in the scope of practice debate when you sit them together to chat.

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With legislation introduced last week into federal parliament to expand the scope of practice of nurse practitioners, the Medical Software Industry of Australia ran a timely panel on the topic featuring a prominent GP, policy maker and pharmacist.

Victorian President of the Pharmacy Guild, Anthony Tassone, who by his own admission can get a bit robust from time to time when posting on the topic on social media, admitted to the panel that this was the first time he’d met Adjunct Professor Karen Price, a prominent GP and past president of the RACGP, and that it was a much more fulfilling and constructive experience than arguing on X (formerly Twitter).

Mr Tassone was nothing but polite and engaging, nothing approaching his social media persona, and you got the distinct sense that both he and Professor Price got something out of the experience of a polite chat with their foe.

Not that they were agreeing on everything.

“The sad reality is there’s enough sickness going around to keep us all busy in the health professional workforce,” told the MSIA audience. “So we need to work smarter, not just harder.

“The broad view is that patients benefit when health professionals work to their full scope, whoever they are. It’s not about pharmacists trying to be doctors.”

Pointing to key overseas examples and evidence around the success of expanding scope of practice to help make his case, Mr Tassone said that scope of practice should not be looked at as task substitution but rather through the lens of workforce and patient requirements.

Mr Tassone could not help himself though.

“I have to say that I’ve never come across a doctor who has said to me, Anthony, thanks to you pharmacists doing more vaccinations and more things like that, my practice is really quiet.”

Rather than taking the bait Professor Price posited that GPs were reacting as if scope of practice was a Trojan horse, because the real issue was keeping continuous care of patients intact.

“We know that continuous care has the greatest impact on health-based outcomes and this is relational care. What we’re concerned about is that there’s a task of classification of generalism,” she said.

“The simple uncomplicated UTI is a retrospective diagnosis. It’s not apparent at the beginning and there may well be herpes simplex or whatever and that’s not going to be able to be assessed properly in a pharmacy.

“There’s all sorts of things that can go on that might present like a UTI and diagnosis is important and GPs have the broadest diagnostic scope here.”

“We know that a patient who has a strong continuous relationship with a pharmacist and a GP who know each other and work together well have some of the best outcomes. So, we’ve got to be careful that we understand the philosophy of generalism, and that we don’t break apart that first primary care contact.

“We know that pharmacists do treat and refer — they’ve done it for a long time. We’re not talking about that. But … we also say that you need more training to do it. That’s a little bit of a contradiction, so we have to work out these boundaries, where patients get the best care the first time. [But] there hasn’t been, as yet, a system that has shown superiority over primary care  [in this].”

Enter the policy (bridge) maker, Daniel McCabe, first assistant secretary of Medicare and digital health at the Department of Health and Aged Care, whose job it is to navigate an increasingly distressed workforce problem via some sort of meaningful truce between what are traditionally warring tribes.

Mr McCabe has a lot of energy and is spinning a lot of policy reform plates at the moment (digital health in particular is charging ahead) but he also has an unusually good helicopter view and grasp of all the issues at play in scope of practice. 

It’s that view which might help him get reform across the line that each stakeholder is okay with in the end, and which does make a difference.  He’s also pragmatic and just a little impatient, which helps.

“We are suffering acute challenges in our workforce in Australia, like every other country around the world and so this is trying look at how we unlock the potential of all of our workforce to operate at their full scope,” he told the audience.

Mr McCabe thinks that amid all the hullaballoo of fighting via various forms of media, what tends to get lost is “how do we build multidisciplinary care” as reform keeps promising it will.

He pointed out that most of the time we don’t have the luxury of having all our care providers under the one roof.

“We don’t always have the luxury of health professionals having the opportunity to know each other as well, so we have to probably get to this in this debate about what does that mean in terms of technology and how do we best support patients as they move across our healthcare system,” he said.

“We are going to need to look at how information can be better shared across practices, across clinics, between specialists with state government hospital services, and ultimately, community pharmacy.

“Obviously, having other health professionals being able to talk to the primary provider of that information is going to be critical. But I don’t think we should live in this sort of paternalistic world and assume that every patient has access to their information.

“We do need to start allowing for information to move much more freely and unlock all the information blocks that exist in healthcare.”

On this point Mr McCabe admitted that the My Health Record will never be the overall solution to information sharing in the system – that it has a place but as a health data sharing construct it has weaknesses that have to be addressed with new technology and reforms.

As a part of this Mr McCabe also said that there were serious inequities in the MBS that had to be addressed which in particular were holding back the potential of general practice.

But that’s probably another policy bun fight for later.