GPs are worried about proposals to reform some aspects of primary care, warning it will make seeing a GP harder for more patients.
Responding to the final report of the Unleashing the Potential of our Health Workforce – Scope of Practice Review, the Royal Australian College of GPs urged the Federal Government to exercise caution when considering the recommendations, warning that they could result in a costlier health system, more delays to care, and higher out-of-pocket costs for patients.
The year-long independent review, headed by Professor Mark Cormack, looked at the system changes needed to support health professionals to work their full scope of practice to optimise the use of resources across the primary care sector.
It found that almost all the nation’s health professions face restrictions and barriers in working to their fullest scope.
It handed down 18 recommendations this month, including the establishment of a primary care workforce development program to support the retention of skilled staff; and removal of unnecessary barriers to supervision in primary care education and training.
It also called for implementation of new direct referral pathways for access to specified non-GP specialists; and a commitment to developing a shared definition of cultural safety across primary care alongside First Nations stakeholders.
The RACGP has raised concerns about the proposal to open direct referral pathways to more health professionals. Under the recommendation non-GP specialists would be able to refer patients needing further treatment, for example a physiotherapist could refer to an orthopaedic surgeon, or a dietitian could refer to gastroenterologist.
College president Dr Nicole Higgins said direct referral to a specialist for something a GP can do would not make the health system more efficient or cheaper for patients.
“There’s also a risk of more inappropriate referrals as patients are sent to non-GP specialists in greater numbers, including specialisations already facing workforce shortages,” she said.
“That will increase out-of-pocket costs for patients already struggling with cost-of-living pressures and delay their care as they wait to see specialists already in short supply.”
She called for GPs to be part of the solution by allowing them to provide more services to ease pressure on other specialists and reduce patient costs.
“This could include allowing GPs to provide more acne treatments, diagnosis and management of ADHD, iron infusions, and medicines with dementia, reducing the need to refer to other specialists,” she said.
The college has cautiously supported other recommendations, including the introduction of a blended payment to enable access to multidisciplinary health care and a body to provide evidence-based advice on workforce innovation.
The Primary Care Business Council has warned that recommendations in the report could put Australia’s primary care network at risk of becoming more costly and fragmented.
PCBC Chair Dr Ged Foley said GPs would be right to be concerned, and the Federal Government needed to ensure Australia did not end up with similar issues as those faced in the US, where access to secondary care is unregulated leading to higher costs and poorer healthcare outcomes.
Other professional bodies were supportive of the report, with the Australian Physiotherapy Association welcoming the recommendations, including for direct referral pathways. National president Scott Willis said the current system left people waiting too long for referral and the care they needed
The Australian College of Nursing and the National Rural Health Alliance also supported the findings.
Other findings of the review include inconsistencies across states and territories that make it harder for patients to get the care they need, and for health practitioners to move to where they are needed.
This was particularly the case in regional and remote areas, where a health professional may be available and yet the regulatory and legislative settings may not authorise or enable them to provide care within their scope of practice.
Federal Minister for Health and Aged Care Mark Butler said the review validated the views of many health professionals that the system did not support them to deliver the care that was within their skills, training and experience.