This time, the organisation is more than just ‘disappointed and frustrated’.
The Australian Medical Association has come out swinging with its latest submission on the Scope of Practice review, as fears grow that its outcome is a foregone conclusion.
It’s a stronger-than-usual stance for the organisation, which ended its submission by threatening to walk away from the table.
“The AMA remains open to engaging, but we can no longer accept hollow assurances that this is not about expanding scope when [the second issues paper] includes this as a mid-term goal, nor will we accept that it is about collaboration when the paper offers nothing but fragmentary models that rely on cashing out core general practice funding,” it said.
Some of the more barbed comments were that the reviewers had “no regard for the fundamental role” of GPs, had “contradict[ed] reassurances” of neutrality and had effectively ignored good-faith submissions from peak GP bodies.
“We don’t usually get this cranky,” AMA vice president Dr Danielle McMullen told The Medical Republic.
One of the biggest bees in the association’s bonnet is the assumption that doctors are completely set against broader scope of practice for allied health.
“There are some really good examples in Australia of primary care teams and general practice team-based care that are showing good outcomes for patients,” Dr McMullen said.
“And so we’ve brought these to the attention, again, of the review team and encourage them to look locally for ideas of what works.”
Successful home-grown programs include grant funding for non-dispensing pharmacists to work in general practice, care navigator trials coordinated by PHNs and practice nurse-run diabetes clinics.
“GPs are more than willing to work differently and work in teams,” said Dr McMullen.
“There are plenty of other systems barriers and we wouldn’t agree that GPs are the barrier to people working to their full scope.”
The association’s central concern is that, much like the movie adaptation of a book, the review has deviated from its source material.
“The [Strengthening Medicare] Taskforce followed the release of Australia’s Primary Health Care 10 Year Plan 2022-2032, which set out a plan to support the reform of primary care built around the central role of general practice … and high-quality team-based models of care,” the AMA submission read.
Instead, the AMA contended, there is not a single mention of GPs or general practice across any of the papers that the review team have put out that does not frame them as an obstacle to reform.
Most often, this was reflected in references to non-doctors taking on “low level GP work” and the complete absence of models that look at GP-led multidisciplinary models of care.
“[We] can only conclude that there is no intention to work with GPs, and no intention to integrate nurses, physiotherapists, psychologists and pharmacists into the primary care team,” the AMA said.
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According to the AMA, one of the fundamental flaws undermining the review’s recommendations was a misconception that scope should be tied to an individual health practitioner rather than a setting.
A nurse practitioner working under GP supervision, for example, would have a broader scope of practice than the same nurse practitioner working solo.
As for the suggestion that there should be the same pay for the same activities – well.
“The AMA fails to see how a single payment rate for specified activities or bundled funding for midwifery would in any way drive anything other than the fragmentation of care, moving more care away from general practice and a patient’s usual GP,” it said.
But that’s not to say the AMA thinks nurses, especially those working in primary care, are paid anywhere near enough.
It cited strong member support for specific MBS items and meaningful pooled funding to support practice nurses to work to their full scope.
With a final report and implementation plan set to be released by October, this is one of the last chances for peak bodies to have their say.
ACRRM has already issued its response, but the RACGP is yet to release its submission.
