First look at scope of practice review

It may seem extremely dull at first glance, but the results of this review could change the entire primary care landscape.

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Depending on the result of the allied health scope of practice review, pharmacists prescribing for urinary tract infections could become the least of your problems.

The review’s formal name is “Unleashing the potential of our health workforce – Scope of Practice Review” and it kicked off in August last year.

The first of two issues papers was released this week.

This first paper, the reviewers have stressed, is only intended “as a starting point for further discussions” and does not draw conclusions nor make recommendations. It’s more a literature review.

Despite these assurances, the paper did make two key findings: that health professionals working at “full scope of practice” will support a stronger primary care system and that Australia has “a range of barriers” in place that prevent this from happening.

There were other clues scattered throughout which appear to give a good indication of the specific policies and models that the review is considering.

For instance, the evidence that it used to reach those two key conclusions was largely drawn from programs in the UK and Canada.

The paper took specific note of the UK’s non-medical prescribing framework, which has allowed physician associates, nurses, midwives, pharmacists, optometrists, paramedics, radiographers, podiatrists, physiotherapists and dieticians with additional training to have prescribing authority.

It also highlighted the family health team model used in Ontario, Canada, where GPs, nurses and pharmacists work together under a blended capitation and salaried funding model.

Speaking at a Department of Health and Aged Care webinar on Wednesday night, lead reviewer Professor Mark Cormack outlined three “potential enablers” that had emerged from the issues paper.

These were: adjusting the National Registration and Accreditation Scheme to ensure that what people are theoretically trained and qualified to do translates into reality; establishing multidisciplinary care teams that target specific patient groups; and “strengthening” primary care clinical governance.

“Certainly, we see quite a difference between the depth and level of sophistication of practical clinical governance mechanisms – this is in the primary health care system compared to the hospital system – in some cases for many good reasons, like the different risk profile,” Professor Cormack said.

“But we think there is a case to build stronger support for primary healthcare orientated clinical governance mechanisms.”

Incoming AMA ACT president Dr Kerrie Aust, a GP in Canberra, stressed the need for effective review of increases to scope of practice.   

“We know there are some areas where our health system has been fragmented … and we don’t actually know whether or not a particular service provision is providing an effective service for patients or whether it’s just costing more because they’re seeing multiple health practitioners all at the same time,” she told webinar audiences.

Diagnostic medicine and clinical evaluation “are not skills that you can learn on a six-week course”, she said.

“It is something that that doctors train in before medical school, during medical school and then during our specialty training.

“We should never lose sight of that.”

One webinar attendee asked Professor Cormack whether, seeing as pharmacists seemed to be encroaching into GP scope of practice, GP clinics should be allowed to sell pharmacy-style products.

“I’m not aware of what the restrictions are – however, I’m sure you’ve probably got other more important things to do with your practice time,” Professor Cormack said.

“But I think this issue of encroachment is really at the heart of the question here … the National Registration and Accreditation Scheme more specifically regulates and protects title than it does protect scope.

“The scope of individual professions is not hardwired into a national scheme, although it certainly is in practice.”

Professor Cormack said there was a case to look at common competencies across professional groups.

A final report and implementation plan from the review committee is expected in October.