… But could very well turn out in GPs’ favour. Maybe. A long, long time from now.
If every cloud has a silver lining, the scope of practice review’s may be that it could help keep medical indemnity premiums down.
According to the second issues paper from the Unleashing the Potential of our Health Workforce Scope of Practice Review, which came out on Tuesday, the reform options under consideration include moving to a “risk-based” regulatory approach as well as introducing parity across MBS rates for similar tasks.
This last would see allied health professionals remunerated the same sum as a doctors for tasks like vaccination, catheterisation, cannulation or cervical screening.
“GPs are trained to know when to not order a test and when to not prescribe,” RACGP president Dr Nicole Higgins told The Medical Republic.
“Opening up the MBS to professions that haven’t had this integrated into their training throughout medical school and throughout their postgraduate training is going to cost a lot of money.
“It’s going to increase the ordering of tests and increase the prescribing of medications, and that’s going to have huge implications to the budget bottom line.”
Greater scope of practice also means greater risk – and wherever there is greater risk, there is an insurance agent.
Dr Higgins questioned whether allied health professionals would be prepared to pay the same insurance premiums as a doctor.
Nurses, for instance, pay around $1500 per year for indemnity; GPs, Dr Higgins said, shell out between $8000 and $10,000 at minimum.
“I’ve asked [review head] Professor Mark Cormack about indemnity, and others have also asked. We were told that it was not really within the scope of the scope of practice review,” she said.
“And comments have been made to the effect of ‘well, it would be okay because as long as a health professional is operating within scope as per AHPRA, it won’t be an issue’.
“We all know that is not how things work – there are unintended adverse outcomes in health care.”
The RACGP president is concerned that there is a lack of understanding about the fundamentals of medical indemnity.
Joel Tuccia, policy and advocacy manager at medical indemnifier MIGA, said it was possible that medical indemnity premiums could stabilise with the introduction of broader-scope allied health professionals.
“In a world where allied health professionals are responsible for their own indemnity insurance and where and the legislative framework empowers them to work to their full scope, then that’s going to shift some of the responsibility away from the medical profession and onto those allied health professionals,” he told TMR.
But it’s unlikely that any effects would be felt overnight.
“It’s a shift in risk, and one thing about insurance companies is that they are very data driven,” Mr Tuccia said.
“They will want to see a trend actually materialise rather than just looking at one or two data points and saying ‘hey, things are getting a bit easier, let’s drop premiums’.”
He also warned that more premiums, more duplication and bigger insurance bills will actually increase the cost of healthcare more generally.
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Avant Chief Medical Officer Dr Michael Wright, meanwhile, told TMR that there was a danger in reducing patients to a collection of symptoms to be treated individually.
“While Avant applauds the review’s acknowledgment of the importance of individual practitioner insurance coverage, technological improvements and funding models, a greater consideration of patient safety is needed,” he said.
“These are complex issues that warrant careful consideration to ensure patient safety remains paramount.
“We support a model that maximises the strengths of all healthcare practitioners within a collaborative team led by the expertise and experience of a GP.”
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.
