Introduction by Croakey: Antony Nicholas, the Chair of Allied Health Professions Australia (AHPA), will speak on the national Scope of Practice review, which is titled ‘Unleashing the Potential of Our Health Workforce’, at a #CroakeyLIVE webinar on 25 June.
In the article below, he argues that changes could be made immediately to unleash the potential of the allied health workforce, ahead of any reforms arising from the review process, and makes five related recommendations.
Antony Nicholas writes:
Allied health practitioners are key to unlocking consumer barriers to primary care. As university educated practitioners, allied health professionals represent almost a third of the country’s healthcare workforce and deliver over 200 million health services annually.
However, the interplay of complex legislative, regulatory, and funding mechanisms, limit the capacity of allied health to consistently work at top of scope in the primary care setting, leading to consumer disadvantage and poorer health outcomes.
Despite higher and higher investment in primary care, Australians are experiencing higher out-of-pocket expenses, less access, longer wait lists, poorer health outcomes and dramatically increasing chronic and complex health conditions. Plus, a GP workforce shortage; clearly the status quo is not working.
While Allied Health Professions Australia (AHPA) recognises the value of the Scope of Practice Review as the pathway to sustained system reform, there are achievable and sustainable recommendations that could be implemented immediately.
These changes would significantly improve the consumer experience, reduce waiting times, and address regulatory barriers to safe, high quality allied healthcare in the primary care setting.
1. Culture and leadership
Despite the centrality of allied health to the improvement of consumer outcomes, we still observe that GP-centric culture continues to drive policy inside the Department of Health and Aged Care. Allied health leadership in the DoHAC sits at a lower level than the equivalent medical and nursing roles, for no reason, other than culture.
This impacts our capacity to shape and influence policy reform. Too often, allied health is on the receiving end of policy that has been designed for general practice and is subsequently shoe-horned into allied health, without the support or subsidies offered elsewhere.
If there is any doubt about the impact of culture, look no further than the Chief Allied Health Officer position. After an 11-month vacancy we look forward to welcoming a new, part-time, Chief Allied Health Officer.
Similarly, allied health representation across primary care and other departmental advisory committees often excludes or limits allied health representation, despite the size and diversity of the sector.
In the short term, AHPA calls on government to include appropriate allied health representation on relevant health bodies, boards and advisory committees. This doesn’t mean a ratio of one allied health representative to four general practitioners. It means an equal footing that allows our sectors to meaningfully collaborate and shape the outcome.
In the long term, AHPA calls on the government to disrupt the status quo.
Primary care reform and innovations are stymied by powerful lobby groups and policy paralysis. Australians deserve access to quality healthcare where and when they need it. This is not going to happen without significant disruption to the prevailing culture of primary care.
2. Acknowledge the skilled role of allied health in primary care
It is critical to acknowledge that allied health professionals have key primary care roles alongside the work of general practitioners and primary care nurses.
By undertaking work with consumers and clinicians to identify, document and fund rebates for consumer to access key primary care pathways where allied health professionals are the primary contact point and/or the primary coordinators of access to other multidisciplinary services.
Many of these barriers have been highlighted to government(s) for years, with little actual reform. Such funding harmonisation would speed access for consumers in primary care, with timely referral for rebated diagnostic imaging, pathology or referrals.
Further this would better utilise a well-trained allied health workforce while reducing wait time or barriers to access general practice.
3. Embed allied health access into the frequent Hospital User Program
Allied health must be integrated into the Frequent Hospital User model of care. The achievement of improved health outcomes for our most vulnerable consumers requires wrap-around multidisciplinary team care, inside general practice but also external to it.
This can only be attained by improving access to the full suite of allied health providers who are skilled at working in multidisciplinary teams. In the long term, new funding models will be necessary to achieve sustained improvements.
In the short term, government can improve access to comprehensive primary care by funding Primary Health Networks to commission allied health services within the Frequent Hospital User Program.
4. Expand Urgent Care Clinics to integrate relevant allied health
Appropriate allied health practitioners should be embedded into Urgent Care Clinics as a matter of routine and systematically evaluated.
A small number of existing urgent care clinics already incorporate exercise physiologists and physiotherapists into the model of care. There is an immediate opportunity to formalise that involvement and measure their impact on consumer outcomes and cost effectiveness.
In the context of a declining general practice workforce, exacerbated in rural and remote areas, there is no sound rationale for the exclusion of professions that can free up GPs to work to top of scope.
5. Fund a formal review of the self-regulation model for allied health professions
The Scope of Practice Review has amplified the need for review and reform of the self-regulation model. Sixty percent of the allied health workforce is self-regulated with remaining professions regulated under the National Registration and Accreditation Scheme.
In collaboration with the National Alliance of Self-Regulating Health Professions (NASRHP), AHPA recently provided a supplementary paper to the Scope of Practice Review.
Together we are calling for a dedicated and appropriately funded review of the self-regulatory model for allied health professions.
Self-regulating health professions lack mandated, formal structures that support the setting of consistent standards to protect consumers and ensure quality.
While NASRHP was established with the intention of filling this gap, it is not supported by government legislation, ongoing government funding, or formal recognition in government policy and programs.
The absence of a funded overarching regulator body appears to be a key driver for the lack of implementation proposals in Issues Paper 2 for self-regulating health professions focused on participation in reform activities and alignment with Ahpra professions.
It is our view that these issues are best addressed by a recommendation in the Scope of Practice Review Final Report calling for an additional, dedicated and appropriately funded review. That recommendation may incorporate the following:
The Commonwealth, in conjunction with the States and Territories, should fund a dedicated, formal review of the regulatory environment for self-regulating health professions aimed at co-designing and supporting the implementation of an evolved model of self-regulation.
The Review should focus on addressing the areas of need outlined by the professions and this review, identifying the legislative changes needed to achieve those outcomes, and the enablers needed to support self-regulating health professions to collaborate with the Ahpra-registered professions in designing and implementing the recommendations from the Review. That includes consideration of incorporation within the National Registration and Accreditation Scheme.
The Review should also focus on identifying how best to support self-regulating health professions to transition from their current structures, enabled as they are by individual Constitutions, to a new model of self-regulation and how to achieve a sustainable model of self-regulation for health professions regardless of size.
AHPA’s full response to the Scope of Practice Review Issues Paper Two is available here.
Register for the #CroakeyLIVE webinar, sponsored by the Australian Society of Medical Imaging and Radiation Therapy, and taking place on Tuesday, 25 June from 5-6pm AEST.
