Substitution is not the answer: RACGP

5 minute read

What will the government’s scope of practice review mean for GPs?

The RACGP has raised concern over “task and role substitution” amid suggestions that the government’s scope of practice review is set to consider everybody’s scope except GPs’.

Last week, Professor Mark Cormack, a senior health official, was appointed head of a federal government review which, at the behest of the Strengthening Medicare Taskforce, aims to shed light  on how to remove barriers that limit the capacity of health professionals.

“Whether it is nurses, pharmacists or allied health professionals, in a global health workforce shortage we need everyone working as close as possible to the top of their scope,” Minister for Health and Aged Care Mark Butler said, making no mention of GPs.

Although the review has been welcomed by the RACGP, the college and its members have raised concerns.

“This review must be about more than just task and role substitution,” said RACGP President Dr Nicole Higgins.

“It’s important our health system recognises GPs are highly trained specialists with a minimum of 10 years’ training,” she said.

“We work directly with patients at every stage of their healthcare, from an initial consultation, to diagnosis, to working as part of a team with other specialists and allied health professionals to deliver high-quality healthcare for all patients.

“GPs are the foundation on which multidisciplinary team care rests.”

Professor Mark Morgan, chair of RACGP quality care expert committee, highlighted three key areas for expansion of GPs’ scope of practice: expanded involvement in shared care, improved access to information and removal of some legislative barriers to GPs prescribing.

“For those patients who have complex long term medical conditions and require specialist teams to help look after them, there’s a great scope for GPs to work more closely with those people, and be able to adjust treatments within ranges, and help make that much more efficient and patient centred,” Professor Morgan said. 

Professor Morgan believes that to achieve this, GPs need to have “rapid access” to specialists.

“It’s a shift towards [other specialists] really working on top of their scope, seeing new presentations that need their expertise – and not reviewing stable long-term conditions, but to allow that task to be done where it’s much more appropriate, which is with the GP.”

Professor Morgan also spoke of the legislative barriers limiting GPs’ scope, including hepatitis B prescription.

Currently, GPs must undergo training to prescribe hep B and C treatment as they are classified as S100 highly specialised drugs. The RACGP called for the removal of this training for GPs earlier this year.

“What GPs really need to enable them to work at full scope of practice are accessible, real-time sources of high-quality information and health pathways,” Professor Morgan added.

Beyond GPs, Professor Morgan suggested that expanding the capacity of other health care professionals, such as nurses and pharmacists, working in a GP-led team would be beneficial in roles “such as running childhood immunisation clinics”.

Professor Morgan suggested that updating certain rebates to allow other health professionals to perform the services, not just GPs, “would be a very sensible way forward”.

But he warned against fragmentation of care caused by role substitution.

According to Professor Morgan, it is vital to consider the variable environments and the intricacies of modern health.

“Due to the complexity of modern life our patients can easily have more than five ongoing health issues simultaneously,” he said.

“There needs to be someone to make decisions when there are difficult decisions confounded by conflicting advice. That someone is a GP – GPs are trained to deal with uncertainty and complexity.”

“We have different pressures in complex urban environments, when there are dozens of suppliers of medicine and of medical care with risks of over-servicing, right through to remote areas where GPs are flat-strapped to keep up with the necessary care.”

Shadow Assistant Minister for Regional Health Dr Anne Webster hoped that the review would have substantial effects on regional health.

“Regional people are disadvantaged in three ways: poorer social determinants of health, a lack of service availability, and higher costs of access and delivery, all resulting in poor health outcomes,” she said.

“Supporting the health workforce to work to their full scope of practice, whether in the city or out in the regions, is one way to alleviate the outcomes of the shortages.

“I hope this review will uncover other ways to ensure that Australians have access to a strong and effective healthcare system no matter where they live.”

Dr Higgins agreed that the benefits of government funding and initiatives should extend to all Australians.

“Medicare Benefits Scheme and Workforce Improvement Program funding should give all Australians access to a GP who can coordinate their care in the community, while also providing high-quality, safe diagnosis by experts and management in the appropriate setting for all health issues,” she said.

“Everyone should be able to access quality, comprehensive healthcare, whether they live in Toorak, Tamworth, or Tenant Creek.”

The report is due to be published late next year.

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