Are we heading for a physician associate moment?

The AMA and GP colleges have warned that scope-of-practice reforms could result in the kind of implosion seen in the UK health system.

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The UK and Canada are valuable case studies for allied health scope of practice – but not for the reason that the scope of practice review commissioners seem to think, the RACGP says.

Commissioned by the Department of Health and Aged Care last year, the Unleashing the Potential of our Health Workforce scope of practice review is set to release its second issues paper in the coming weeks.

The first issues paper was released in January. It was ostensibly a literature review of sorts and only intended to be “a starting point for further discussions”.

Still, it made two key findings: that health professionals working top of scope make for a stronger primary healthcare system and that Australia has a range of barriers to achieving that.

The reviewers specifically noted that “policy and practice examples from the UK and Canada [in particular] were … found to be highly relevant to the Australian context”.

Responding to the issues paper this week, the RACGP said that “Australia should learn from the UK … on what not to do”.

The number of UK doctors working in Australia has doubled over the past decade, and the government’s commitment to expanding the non-doctor physician associate workforce has created a fallout so large it has threatened one of the oldest medical colleges in the world.

“Australia is in the top three health systems in the world, and the NHS is a basket case,” RACGP president Dr Nicole Higgins told The Medical Republic.

“We’ve got NHS doctor refugees and patients who are leaving in droves because it’s a broken system, and Australia can’t afford to go down that pathway.”

The college submission also pointed out that the Canadian province of Alberta, where pharmacists are allowed to prescribe for a variety of conditions, is experiencing an acute doctor shortage.

One board member of the Alberta College of Family Physicians has publicly blamed the workforce issues on a lack of governmental support for primary care.

The RACGP also homed in on something it felt was missing from the first issues paper: recognition of general practice.

“Issues Paper 1 is deafeningly silent on the large body of high-quality evidence for general practice,” it said.

“The review is overlooking the existing broad scope of general practice and the benefits for patients when GPs and their teams are enabled to work at their top of scope.

“Focusing only on increasing the number of access points will not have the same impact.”

Instead of responding to the individual consultation questions put out by the review, the RACGP chose to present lists of recommendations and risks.

High up on its list of recommendations were facilitating general practice-based dispensing, recognising GP advanced skills and increasing funding to support multidisciplinary team care.

This last includes opening MBS rebates for services delivered by practice nurses without direct GP supervision.

The lists of potential risks were equally voluminous. Chief among the college’s concerns were waitlist blowouts should allied health professionals be allowed to refer to specialists, patient confusion about who was a doctor and the increased administrative burden when relying on tools like My Health Record.

“My Health Record is not a clinical record; it is a summary of patient encounters,” the RACGP said.

“It is not sufficient to provide good patient care … [and] is also reliant on patients choosing not to opt out, which many did when the tool was first launched.”

The GP college also took issue with several of the definitions used by the review team, including one reference to the “acute health system”.

“Does ‘acute health system’ translate only to hospitals?” the RACGP wrote.

“GPs provide care of acute problems, such as lacerations or pneumonia, and should therefore be considered part of the acute care system.”

Although the AMA has not publicly released its submission yet, it told TMR that it would not be supporting “shortcuts” to tackling GP shortages.

“Our members have raised a number of concerns and it’s critical the scope of practice review provides a process to genuinely address the AMA’s concerns,” a spokesman said. 

“The AMA also rejects suggestions that all identified ‘barriers’ are obstacles that should be removed, because some of the so-called barriers provided safeguards.”

ACRRM’s submission to the consultation, while acknowledging the opportunity it presented for rural generalists, was similarly scathing.

“We are disappointed that the initial analysis and evidence review appears to have concluded that broadening of scope of practice would have virtually universal positive outcomes without any reference to potential risks or unintended costs,” the rural college said.

“In particular while referencing rural success stories it has not identified any need for caution, or a nuanced approach to considering implications in contexts characterised by geographic isolation, minimal resourcing, limited patient pools, and pervasive workforce shortages.”

The bulk of the ACRRM submission focused on different funding and business models that could help boost healthcare in the bush – single employer models, blended funding models, public funding for private clinics, and GP-consultant models all got a mention.