There’s something deeply skewed about the scope of practice discussion papers, the RACGP says.
The scope of practice review used around 1100 sources to inform its thinking on the future of primary healthcare in Australia.
Almost half of these related to a single profession, and just 130 looked at physician-led models of care.
With the final report from the inquiry due in October, the RACGP has finally released its May submission to the second issues paper.
The issues paper detailed eight reform options, which included allowing allied health professionals like physiotherapists to refer and opening up the MBS and PBS to every primary health profession.
While the college did not go as far as the AMA, which threatened to walk away from scope of practice discussions entirely, it accused the review of “deviating from … the review’s own terms of reference”.
“The RACGP is concerned about the direction that the scope of practice review is heading, with the role of GPs and general practice a glaring exclusion in the consideration of such significant reform in the Australian healthcare landscape,” the RACGP said.
By the college’s count, there were 532 sources which looked at nursing-led models of care and 211 that looked at pharmacist-led care, but just 130 looking at doctor or GP-led care.
“General practice in Australia provides 86% of all primary care, and yet the research that was used to demonstrate the recommendations in the scope of practice review did not accurately reflect that,” RACGP president Dr Nicole Higgins told The Medical Republic.
Dr Higgins also reiterated that just because the final scope report may include certain recommendations, it does not automatically follow that it will be adopted.
Because all health professionals have a lack of visibility over the patients that they don’t see, the RACGP said, it’s inaccurate to make assumptions about appropriate management by other allied health professions.
In Australian contexts at least, allied health professionals are not typically managing an undifferentiated patient cohort; they are only managing the patients who have been referred to them by GPs.
One of the fundamental flaws with the review, according to the RACGP, is that it frames healthcare as a commodity and regulation as a barrier to consumers purchasing a desired product.
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Prioritising patient choice over GP gatekeeping, it warned, will likely result in unnecessary appointments and investigations. This translates to an increase in spend by government.
“Multidisciplinary care works best once the establishment of diagnosis or differential diagnosis has occurred,” the college said.
“Physiotherapy of course is the best place for back pain, except when it turns out to be metastatic prostate cancer, or myeloma or a presenting symptom of depression.”
In the most recent update from review lead Professor Mark Cormack, which was released in mid-August, he said the team had identified that there was “a significant cultural shift” required before people would embrace multidisciplinary learning.
Since it kicked off late last year, he said, the review had received more than 1135 submissions.
