Referrals that bypass GPs and ‘same pay for same work’ are among a swag of options outlined in the latest report from a scope of practice review.
The future of primary care in Australia could be improved by supporting health professionals to work to their full scope of practice, according to the Unleashing the Potential of our Health Workforce, Scope of Practice Review.
Legislation and regulation have been acknowledged as ‘fundamentally shaping scope of practice,’ and the independent review, led by Professor Mark Cormack, is being held in four until October, with a focus on:
- Limitations on which health professionals can refer patients to other health professionals or request R-type diagnostic imaging services for patients under the MBS
- The ability of nurses to deliver mental health care services in the community under the MBS, including being able to diagnose and treat mental health conditions
- Inconsistencies in the fees prescribed for MBS services undertaken by different health professionals.
The update noted that the Health Insurance (General Medical Services Table) Regulations 2021 and Health Insurance Act 1973 – and its associated regulations and determinations – were so ‘highly prescriptive’ about access to MBS-funded services that they have ‘a significant, practical impact on health professionals’ scope of practice.’
“There is a high degree of specificity in the Health Insurance Act in relation to referrals to other health professionals or to request pathology or imaging for patients under the MBS,” it said.
Funding and payment arrangements impede health professionals working to their full scope, the report said. It prevented some health professionals from referring patients for services, resulting in them having to return to their GP to obtain the referral.
One possible solution involved expanding alternative funding models – block, bundled and blended funding – to complement the existing MBS fee for service approach. The new blended payments would be aligned with Strengthening Medicare reform and be available to practices, practice groups and primary care provider organisations to fund and support a flexible mix of health services to meet local health needs.
The second mechanism would be the introduction of a single payment rate for specified activities falling within overlapping scope, introducing parity across professions undertaking effectively identical service delivery. This would apply to a limited number of specified activities which fall under the current scope of multiple professions, such as vaccination, catheterisation, cannulation, cervical screening and wound care.
The third mechanism would be the introduction of bundled funding for the midwifery continuity of care model as a defined care pathway, to fund midwives to work to their full scope when they practise across different parts of the health care system (including primary and admitted care) which currently operate under separate funding arrangements.
Should the reform options be adopted, health professionals working to defined conditions would also be enabled to refer patients directly to another health professional and/or for pathology or diagnostic investigations.
“This streamlined referral pathway includes digital notification of the consumer’s home GP where available but reduces the requirement to visit to the GP to obtain referrals, resulting in a more efficient process and an improved consumer experience resulting from unnecessary GP visits and quicker access to required treatment,” the report said.
“Overall, GPs are expected to be less burdened by low-value episodes of care where the consumer seeking a referral has already been instructed to do so by a relevant health professional.”