Aboriginal and Torres Strait Islander-run clinics are already implementing the bright ideas outlined in the Medicare report, but could their success be threatened?
The National Aboriginal Community Controlled Health Organisation (NACCHO) says the team-based primary care foreshadowed last week in the Strengthening Medicare Taskforce’s report has been a model of Indigenous healthcare for years.
However, on Friday NACCHO also flagged its concern about how expanding pharmacists’ scope of practice could affect the quality of primary care for Aboriginal and Torres Strait Islander people.
“Our community-controlled health services are the Australian leaders in coordinated, multidisciplinary primary health care,” Donnella Mills, NACCHO chair, said in a statement. “Our clinics work through large multidisciplinary teams made up of Aboriginal and Torres Strait Islander health workers and practitioners, nurses, pharmacists, general practitioners, and non-GP specialists.
“ACCHOs currently employ three nurses or Aboriginal and Torres Strait Islander health workers for every one GP and have developed effective models for integrating pharmacists within primary health care teams.”
The Strengthening Medicare Taskforce report recommends, among other things, increasing investment in WIPs to support multidisciplinary teams. However, its recommendations are based on aiming “to coordinate multidisciplinary teams of health care professionals working to their full scope of practice”, with the language suggesting a significant broadening of pharmacy practice could be on the cards.
NACCHO medical adviser Dr Jason Agostino told TMR that children with otitis media could receive inappropriate treatment if pharmacy scope of practice were expanded without check.
“Aboriginal and Torres Strait Islander kids have some of the highest rates of ear disease in the world,” NACCHO medical adviser Dr Jason Agostino said, “and that leads to hearing loss that then contributes to poor educational outcomes and even interactions with the prison system. But the answer isn’t easy access to antibiotics – that leads to increased antibiotic resistance. The answer is coordinated care, and the Pharmacy Guild doesn’t offer that.
“We are the places in Australia that are already doing a lot of the things within the Medicare taskforce’s report. I already work within a clinic that has visiting physiotherapists, visiting audiologists, and visiting diabetes educators. I have a paediatric endocrinologist who comes to my clinic as well as renal nurses. We have a broad, integrated team, led by GPs.”
But while ACCHO clinics might already be doing what’s being recommended in the taskforce report handed down on Friday, funding remains a problem.
“It’s not funded in an efficient or sustainable way,” Dr Agostino said. “To achieve this amazing thing that we do, we have to piece together a bit of grant funding from state and territory governments, funding from the Commonwealth government, a bit of a project-specific funding and so on.
“What that leads to is funding instability and staffing instability and the inability to scale up and spread these sorts of programmes.”
Pat Turner AM, the CEO of NACCHO, said she was also concerned about how independent pharmacy prescribing could affect Indigenous healthcare.
“Industry groups continue to push for expanded scope of practice, without the integration within a primary health care team,” Ms Turner said in a statement. “This is most notable in the pharmacy sector where expanded scope trials are being conducted in areas with large numbers of Aboriginal and Torres Strait Islander patients.
“These trials threaten to further fragment care for priority conditions such as otitis media and hearing loss, hepatitis management, and further exacerbate the crisis in antimicrobial resistance seen in many Aboriginal and Torres Strait Islander patients.
“While there has been years of consultations and various task forces and committees reviewing scope of practices and access to care for patients, including the recent Medicare Strengthening Taskforce, which had representation of a range of clinicians involved in delivering primary health care, the same cannot be said of this pursuit by private pharmacy.”