The roles of healthcare professionals are still unfortunately often stuck in the past. That is, before the training of nurses and other healthcare professionals moved to universities in the Nineteen Eighties. So many are still not working of their full scope of practice.
There has been some expansion of their roles lately to include pharmacists prescribing (in limited circumstances) and administering a wider range of vaccines.
But recently released paper an independent Commonwealth review into the ‘scope of practice’ of health professionals highlights the myriad barriers stopping Australians from fully benefiting from the skills of health professionals.
These include the structure of the workforce (who does what, where and the way roles interact), laws and regulations (which regularly vary by jurisdiction), and the way healthcare staff are funded and paid.
There isn’t any easy, quick solution to this sort of reform. But we now have a reasonable path to improving access to health care that makes appropriate use of all health care staff.
A brand new vision for general practice
I recently had a booster dose for Covid. To do that, I logged on to my practice’s website, answered the query about what I wanted, booked an appointment with a nurse at the practice that afternoon, got stabbed, received a collective invoice, sat for a while, after which went home. There is nothing unusual about this.
But this interaction required many facilitating aspects. The Victorian Government regulates whether nurses can provide vaccinations and what additional training a nurse requires. The Commonwealth Government has allowed the practice to be paid by Medicare for the work of a nurse. A enterprise capitalized practice owner has done all the calculations and decided that it makes economic sense to allocate a room to a nurse practitioner.
The future of primary care involves greater use of other health care professionals, not only primary care physicians.
It can be nice if my general practice also had a physiotherapist I could see if I had back pain without seeing my GP, but I’m not eligible for Medicare reimbursement on this case. This solution would require each health care providers to have access to my health records. Trust and good communication between them can be obligatory, as the physiotherapist may feel that the GP must be notified of any problems.
This vision is for integrated primary care by which health care professionals work as a team. A nurse should give you the chance to do greater than just administer vaccinations and check vital signs. Do I actually need to see my GP each time I would like to renew my prescription for my usually used medicines? This is the crux of the “scope of practice” problem.
What about pharmacists?
An integrated future isn’t the only future on the table. Pharmacy owners particularly argued that pharmacists should give you the chance to practice independently of general practitioners, prescribing and shelling out a limited range of medicines.
This will inevitably reduce continuity of care and potentially create risks if the GP doesn’t know what other medicines the patient is taking.
However, a greater role for pharmacists advantages patients. It is commonly easier and cheaper for a patient to go to a pharmacist, especially when wholesale fee rates fall, which is one of the the reason why prescribing by independent pharmacists is gaining in popularity.
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About every five years, the government negotiates an agreement with the Pharmaceutical Guild, a corporation of pharmacy owners, on how much pharmacies pay for shelling out medicines and other services. These agreements are called “Community Pharmaceutical Agreements”. Independent prescribing by pharmacists could also be part of the program next dealthe details of that are currently being negotiated.
GPs don’t like competition from this recent source, regardless that GPs can have plenty of work for the foreseeable future. So their organizations emphasize the risks of these changesreopening centuries-old turf wars disguised as concerns about security and risk.
Who pays for all this?
Funding is the basis of scope of practice disputes. As with many political debates, either side have merit.
It is obvious that the Government must increase its support for comprehensive general practice. Existing fee-for-service funding for health care services must be redesigned and supplemented with payments that enable practitioners to engage a range of other health professionals to form health care teams.
This must be the foremost thrust of primary care reform and the final Scope of Practice Review report should make this clear. It must concentrate on the overall goal of higher primary health care, not only the aspirations of individual health care professionals and dealing as a team, moderately than in a skilled silo, based on the specialist’s full scope of skilled practice.
At the same time, governments – state and federal – must be sure that all health care staff are utilized to the best of their abilities. It is a waste to have highly educated specialists who don’t fully use their skills. The recent funding arrangements should facilitate higher access to look after all suitably qualified healthcare professionals.
When prescribing medications, it is feasible to reconcile the aspirations of pharmacists with the concerns of general practitioners. New solutions could mean that pharmacists can only renew medicines once they do they’ve contracts with a family doctor and there’s good communication between them. This could also be easier in rural and suburban areas where pharmacists are higher known to GPs.
The second problematic document highlights the complexity of achieving the scope of practice reforms. But it also charts a reasonable path to improving access to health care while making appropriate use of all health care staff.