GP-free referrals mooted in scope of practice review

The RACGP president is urging members to remember that not every recommendation will be put into practice.

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The government’s scope of practice review has reached another milestone this week with the release of eight reform options, which run the gamut from harmonising drug and poisons regulation to doing away with the need for GP referrals.

Each option is laid out in detail in Unleashing the Potential of our Health Workforce Scope of Practice Review Issues Paper 2, the much-anticipated sequel to February’s Unleashing the Potential of our Health Workforce Scope of Practice Review Issues Paper 1.

Where issues paper 1 was more of an agnostic literature review, the new report details specific reform options.

They come under three broad banners: workforce planning, legislation/regulation and funding policy.

Some are unlikely to prove controversial – option one, for instance, entails creating a skills and capability matrix that sets out the skills and capabilities of each health profession.

The goal here is simply making it easier to understand who does what in primary healthcare.

“Stakeholders described challenges in understanding the scope of professional colleagues as well as frustration at not being recognised for the skills they have,” the reviewers wrote.

The other two reform options that fall under the workforce theme were developing primary healthcare capability and ensuring that tertiary study and continuing professional development for all healthcare workers includes “multi-professional learning”.

Options under the regulation theme include harmonising state and territory drug regulation, running independent assessments of innovation and change in health workforce models to inform legislation and pivoting to a risk-based approach to regulating scope of practice.

Despite sounding innocuous, the pivot to a risk-based regulatory approach has the potential to upend medicine.

The current legislative mechanisms – e.g. the Health Insurance Act 1973 – apply a “named profession” or “protected title” approach to regulating scope.

While the reviewers note that this approach has “generally served Australia well in a protection of public safety sense”, they also decry the “downsides for scope of practice”.

They go on to state that the regulatory environment “arbitrarily limits scope of practice” by focusing on specifying named professions, and that there is “significant prescriptiveness” when it comes to activities funded by the MBS.

“The Health Insurance Act is particularly prescriptive about the requirement for a medical professional to instigate, oversee and approve activities performed by non-medical health professionals in a multidisciplinary care team setting, resulting in an overall medico-centric model of primary health care and restricted scope for most other professions,” the reviewers said.

RACGP president Dr Nicole Higgins told The Medical Republic that the college was steadfastly against fragmented care.

“You get the best outcomes when GPs and healthcare teams work together in general practice,” she said.

“The health system can’t afford to have people broken down into tasks and bits.”

Opening up the MBS and PBS to every primary health profession, Dr Higgins pointed out, would cost a lot of money.

The final two recommendations, which fell under funding and payment policy, were to fund payment models that incentivise multidisciplinary care teams and to allow direct referral pathways supported by technology.

In the recommendation on referrals, the reviewers pointed to instances where a referral to another health professional would be within the competency and training of a certain health professional but would not draw a Medicare benefit.

A physiotherapist, for example, has to refer a patient back to their GP to ask for a referral to an orthopaedic surgeon.

“This may result in unnecessary duplicative service delivery and limits the extent to which a health professional can exercise their professional judgment i.e. work to their full scope of practice,” the review team said.

Dr Higgins said she had already warned Health Minister Mark Butler that GPs were unlikely to be thrilled with the reform options.

“Just because it’s a review doesn’t necessarily mean it will be implemented, which is why it’s important that all GPs tell their member of parliament what their concerns are with this,” she said.

“I’ve already told the Health Minister that there are 40,000 GP members who are really going to push back.”

The release of issues paper 2 marked the beginning of the third phase of the review, which will now move on to another round of stakeholder forums.

A draft final report and implementation plan is due in September.