Unlike the note of caution from some doctor-facing organisations, other corners of the health sector – allied health, pharmacy, nursing – were somewhat more enthusiastic.
The Scope of Practice Review had something for everyone: an independent advisory body on scope reform, bundled, cross-setting payments for maternity care, more block payments and beyond.
Yesterday, Professor Mark Cormack and his team released the final report of the long-awaited scope of practice review, including 18 recommendations
As reported yesterday, the response from many doctor-facing organisations – including the AMA and RACGP – urged caution.
The reactions from other corners of the health sector – including bodies representing allied health, pharmacy, nursing and midwifery – were of a somewhat more enthusiastic inclination.
While the through line was support for an expansion of scope – or working to full scope depending on who you ask – the focus homed in on some different recommendations.
Recommendation 9 – establish an independent advisory body on workforce innovation
The report found that the roll out of reforms to scope of practice – possibly alluding to the recent expansions of pharmacy scope and of nursing scope – had been “unnecessarily complex” and tended to involve “ad-hoc” and “siloed” workforce development, hindering timely adoption of better practice.
The board recommended the development of an independent advisory body to provide evidence-based recommendations to ministers, governments, national boards and regulators on significant changes to scope of practice or other large-scale workforce changes.
The members would be appointed by health ministers, but would not represent government, industry or organisations.
The report suggested that the advisory body also be responsible for the development of a National Skills and Capability Framework and Matrix (recommendation 1), which would outline the responsibilities and skills of the members of the primary care workforce.
Professional bodies would be expected to align their accreditation and standards to the matrix.
The hope was that this would foster trust and cohesion within multidisciplinary teams.
The Australian College of Nursing’s national director of professional practice Karen Grace said recommendation 9 would be pivotal to the nursing workforce.
“[It] talks about establishing an independent mechanism to provide evidence-based advice in relation to workforce innovation, and that speaks to development of innovative models of care that work to the scope of all the health professionals within the team, including nurses,” she said.
“Those models would need to be supported through blended funding models, because the current funding structure wouldn’t be fit for purpose at this point in time.
“On top of that, there’s a whole range of regulatory and legislative barriers that need to be addressed, particularly in relation to differences in legislation between jurisdictions.”
Recommendation 11 – a bundled payment model for maternity care
According to the report, the current funding system impacts the continuity of maternity care across the multiple settings within which the care is provided.
The report recommended public and private sector models of “bundled” payment for maternity services – including midwifery continuity of care models, traditional midwife plus medically led models, or GP shared care models – that could span across hospital and primary care settings.
In the public sector model, the bundled payment would, in most cases, be made to the Local Health Network.
In the private model, change would involve amendment of the Private Health Insurance Act and Health Insurance Act 1973 and a new Private health Insurance product that covered hospital and primary care.
The Australian Nursing and Midwifery Federation championed the recommendation.
ANMF federal secretary Annie Butler said the proposed model – which was born from international examples – would allow maternity care teams to work to the full scope of their skills across different facets of the health system.
It would also reduce inefficiencies in the healthcare budget caused by the current MBS arrangement, said Ms Butler.
Recommendation 10 – more block payments for primary care
This recommendation was significant to the whole of the public primary care sector.
It supported a shift in the payments by the federal government for primary care services from 90% fee-for-service and 10% block funding, to 60% and 40% respectively.
Ms Grace said while it was difficult to pick a “most important” recommendation, blended funding models would be a “huge win” for nursing.
She said it would enable the introduction and scaling of nurse-led and team-based models of care, supporting nurses to work to their full scope.
“At the moment, under existing Medicare funding models, it can be really problematic for nurse-led and interdisciplinary models of care to effectively remunerate every healthcare professional that’s part of the team that’s providing care, which limits the scope of some of those programs,” she said.
In the allied health sphere, Australian Physiotherapy Association national president Scott Willis said the report offered the structural reform necessary to improve care and collaboration.
“APA welcomes the proposed shift towards a blended payment model, a much-needed step for equitable funding that supports multidisciplinary teams in delivering high-quality, patient-centred care,” he said.
Related
Recommendation 12 – non-doctor referrals
Currently, non-GP specialists can only access MBS rebates when a patient is referred to them by a GP.
The report recommended expanding access to rebates for non-GP specialists when referred to by a non-doctor working “within their scope of practice”.
The ANMF welcomed the recommendation which would allow nurse practitioners, remote area nurses and endorsed midwives to make direct referrals for a wider range of procedures and services with MBS rebates.
“It’s just common-sense that a nurse practitioners or a remote area nurse in a rural or rural setting should be able to order blood tests or an x-ray, without people having to drive long-distances to get a doctor to sign a form,” said Ms Butler.
Pharmacy will take the lot
Brimming with excitement, the Pharmaceutical Society of Australia couldn’t pick a favourite recommendation.
The society called on the government to implement all 18.
PSA national president Associate Professor Fei Sim said the report reaffirmed the position that “inconsistent regulations, unnecessary restrictions on practice, and siloed workforces” were negatively impacting patient access to quality care.
“Pharmacists are some of the most accessible healthcare professionals in our communities, yet regulatory barriers continue to limit our ability to provide care when and where our patients need it,” he said.
“The release of this final report is the next step towards breaking down these barriers through a short- and long-term reform agenda, addressing the inefficiencies in our health system.”
Moving forward
While, as RACGP president Dr Nicole Higgins told TMR yesterday, the recommendations remain just that – recommendations – the appetite to enact change from the federal government was seemingly significant.
When asked about said appetite on ABC AM, Mr Butler said he was “very determined” to remove any “artificial, inefficient restrictions” to scope, “along with improving the digital capability of a system that uses still far too many fax machines and too much paper”.
“This is a really important reform opportunity, because, at a time where demand for health is growing and will grow, as long as I can see into the future, and workforce is hard to come by, it just doesn’t make sense not to use every skerrick of skills and training that all of our health professionals have, from GPs through to nurses through to pharmacists, physios and more,” he said.
