While the Federal Government’s determination to introduce a copayment for general practice consultations has been dominating headlines, a recent change to the Medicare Benefits Schedule is causing great concern for services for Aboriginal and Torres Strait Islander peoples.
Louise Lyons, Acting CEO of the Victorian Aboriginal Community Controlled Health Organisation (VACCHO), says the change undermines the role of Aboriginal Health Workers (AHWs), and has called for it to be revoked pending further work around the national registration of AHWs.
Louise Lyons writes:
VACCHO was established in 1996, and is the peak Aboriginal health body representing 100% of Aboriginal Community Controlled Health Organisations (ACCHOs) in Victoria. The role of VACCHO is to build the capacity of its membership (24 full and 3 associate members), and to advocate for issues on their behalf.
VACCHO’s vision is that Aboriginal people will have a high quality of health and wellbeing, enabling individuals and communities to reach their full potential in life. This will be achieved through the philosophy of community control.
ACCHOs have a proud history as sustainable, grassroots organisations that assist in building community capacity for self-determination. ACCHOs are committed to assisting every Aboriginal person to realise their full potential as a human being and as a member of their community.
VACCHO believes that each Aboriginal community needs its own community based, locally owned, culturally appropriate and adequately resourced primary health care facility.
As services and support offered through our ACCHOs are integral to the health, social and emotional wellbeing of Aboriginal people, so is the role of Aboriginal Health Workers (AHWs) as part of the clinical team and critical for ensuring key health issues or concerns are raised and managed appropriately.
Changes to the Medicare Benefits Schedule (MBS) Item 715 that came into effect on January 1st 2015, “Health Assessment for Aboriginal and Torres Strait Islander People”, will greatly impact on the role Aboriginal Health Workers have had in the assessment.
They will no longer be able to participate in the billable items detailed as part of the health assessment – only an Aboriginal Health Practitioner (AHP) or practice nurse is able to assist the medical practitioner under supervision.
While VACCHO appreciates that the policy intent for this change was to reflect the implementation of national registration for AHPs in 2012, the registration of AHWs as AHPs has not occurred in any significant numbers outside of the Northern Territory.
VACCHO fully supports the professionalisation of the Aboriginal health workforce, and the registration of AHWs as AHPs, however, we believe that this MBS change has been implemented too early for health services to adapt – there are just nine AHPs registered in Victoria.
This means that the vast majority of Aboriginal people in the state will not access the cultural and clinical skills of an Aboriginal Health Worker during their health assessment, and this will be detrimental to the patient and their health outcomes.
VACCHO is also concerned that the change will diminish the value of AHWs who are not able to register as they do not yet have the appropriate qualification.
VACCHO recommends that there be:
- broader industry consultation so that a greater, richer appreciation for the issue can be taken into consideration;
- promotion of pre-registration training;
- promotion of the benefits of registration to health services, and support for job role/award restructuring; and
- in the interim, the reinstatement of AHWs within the MBS item 715 as a “suitably qualified health professional” to assist the medical practitioner in the health assessment.
VACCHO will be closely monitoring this issue and will seek consultation with government and other key stakeholders to ensure that there is an appropriate framework and timeline established for the professional development and registration of AHWs to become Aboriginal Health Practitioners.
• Croakey is keen to hear from other health organisations and states/territories about the impact of this change.