Introduction by Croakey: Proposed national scope of practice reforms are important for improving Aboriginal and Torres Strait Islander communities’ access to culturally safe health services, according to Karl Briscoe, CEO of the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP).
The recommended reforms – which face competing agendas from various professional organisations – have also been welcomed by Dr Elizabeth Deveny, CEO of the Consumers Health Forum, who said they could improve equity and reduce financial barriers for consumers.
Despite many complexities, challenges and obstacles, the National Scope of Practice Review’s “emphasis on collaboration and consumer-centred care provides a strong foundation for change”, reports Jason Staines.
Jason Staines writes:
The recently released Unleashing the Potential of Our Health Workforce report could be a pivotal moment in reform Australia’s healthcare system.
Led by Professor Mark Cormack, the review outlines 18 recommendations that could fundamentally reshape healthcare delivery by letting professionals work to the full extent of their training and skills. However, much will depend on how the Government navigates the competing interests at stake to implement the review’s recommendations.
Health Minister Mark Butler says the review was a necessary step toward addressing inefficiencies and inequities in healthcare.
“This review validates the frustrations of so many of our incredible health professionals: the health system does not enable and support them to consistently deliver the care that is within their skills, training, and experience,” he said during a radio interview following the report’s release.
The review’s emphasis on removing artificial restrictions and introducing new funding models has been welcomed by some healthcare groups but criticised by others. While the review presents a roadmap for reform, implementation will need to overcome significant political, logistical, and professional hurdles.
What the review proposes
At the heart of the review is a call to modernise Australia’s healthcare workforce through three main areas: workforce design, legislative harmonisation, and funding reform. These are aimed at removing barriers that prevent professionals such as nurse practitioners, pharmacists, and allied health workers from practising to their full potential.
Coinciding with the review’s release, Croakey has previously looked at examples of how health practitioners were already expanding their areas of practice, with direct impacts on their local communities. Among the issues raised by practitioners were a need for specialised training, and better connections for those working in rural and remote areas.
One of the cornerstone recommendations from the review is the development of a National Skills and Capability Framework. This aims to provide a clear, consistent understanding of the skills each professional group brings to the healthcare system, fostering better collaboration and reducing interprofessional tensions.
Another key proposal is the introduction of direct referral pathways. Under this reform, nurse practitioners and allied health workers could refer patients directly to specialists, bypassing the need for a GP referral in certain cases. Proponents argue such changes would reduce delays and improve access to care, particularly in rural and remote areas where GP shortages are most acute.
The review also calls for a shift from the traditional fee-for-service payment model to blended funding arrangements, which Minister Butler described as essential for providing “wraparound care” for patients with chronic conditions.
Diverging views
Reactions to the review have been divided, as Charles Maskell-Knight has previously described in The Zap.
Peak doctor groups, including the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA), have voiced strong reservations.
RACGP President Dr Nicole Higgins raised concerns about fragmented care, warning that “information will be scattered around the health system without one health provider knowing what somebody else has done”. The RACGP and AMA also point to risks associated with increased out-of-pocket costs and inappropriate referrals, drawing parallels to the troubled National Health Service (NHS) model in the United Kingdom.
In contrast, groups representing nurses, midwives, and allied health professionals have largely embraced the recommendations. Professor Kathryn Zeitz, CEO of the Australian College of Nursing, said “the community benefits when the nursing profession is empowered and supported to work to its full scope of practice”.
Dr Elizabeth Deveny, CEO of the Consumers Health Forum, said the reforms could improve equity and reduce financial barriers for consumers. “Consumers want accessibility and fairness prioritised. These changes should lead to reduced or eliminated out-of-pocket fees,” she told Croakey.
“If practitioners were operating in this way, what I imagine it would result in is consumers having greater control of their healthcare – whether by maximising continuity of care by having more services by the same provider or by receiving more timely care by using a range of providers.
“This would vastly improve the experience for many consumers, particularly those who rely on a healthcare team to help manage their chronic or multiple conditions,” she said.
Some stakeholders have raised concerns about potential insurance implications if practitioners are perceived to work outside their defined scope. Since professional indemnity insurance often relies on clear boundaries around authorised activities, the concern is that uncertainty about these boundaries could lead to coverage disputes.
However, the report outlines mechanisms to mitigate these risks. Central to this is the development of the National Skills and Capability Framework, which would clearly define competencies and align them with professional roles. Enhanced clinical governance frameworks would provide robust oversight, ensuring adherence to these defined scopes.
Additionally, activity-based regulation would focus on authorising specific tasks based on risk and competency, while consistent training and accreditation standards would prepare practitioners to confidently meet these expectations.
Others have queried the financial and operational implications of pharmacists providing GP-type services. Concerns include how consultation fees are determined, who oversees the monitoring of these fees, and whether patients may face additional costs if referred to a GP after an initial pharmacy consultation.
According to the Pharmaceutical Society of Australia (PSA), the cost of pharmacy consultations varies depending on the jurisdiction and funding model. For example, under Queensland’s Community Pharmacy Scope of Practice Pilot, consultation fees are set by the Queensland Government, with detailed information available online.
In other jurisdictions, costs may be borne privately by patients or covered by state government programs. Monitoring and data collection for these pilots is managed by the respective state or territory health departments. While the PSA is not directly involved in evaluating these programs, state governments are expected to oversee the evaluation of service delivery, including referral patterns and patient outcomes.
Indigenous health perspectives
Indigenous health services have often been overlooked in discussions about the need for such reforms, but their inclusion is vital to ensuring equitable outcomes.
Karl Briscoe, CEO of the National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP), said there was an urgent need to harmonise the scope of practice for Aboriginal Health Workers (AHWs) and Aboriginal Health Practitioners (AHPs) across Australia.
“By harmonising a scope of practice, our communities will benefit from culturally safe health services, increasing access and improving outcomes,” Briscoe told Croakey.
Briscoe said AHWs and AHPs are often the first point of clinical care within Aboriginal Community Controlled Health Organisations (ACCHOs). These professionals deliver primary care, health education, and chronic disease management while navigating systemic challenges unique to Indigenous communities.
However, legislative inconsistencies across jurisdictions often restrict their ability to provide care that aligns with their training and the needs of their communities.
“These inconsistencies mean that Aboriginal Health Workers and Practitioners face unnecessary barriers in delivering the care they are capable of,” Briscoe said.
“A national clinical guideline to standardise practice is not just a reform – it is a necessity for ensuring our people can access effective and culturally safe healthcare no matter where they live.”
He also said expanding the scope of practice for Indigenous health workers could address chronic workforce shortages in rural and remote areas. Many AHWs and AHPs are embedded in their communities and bring invaluable cultural knowledge to their roles, making them uniquely positioned to deliver patient-centred care.
Briscoe also called for greater investment in training and education to support AHWs and AHPs.
“Ongoing professional development, backed by systemic support, is crucial. It ensures our workforce remains skilled and confident in their roles, especially as the demands of healthcare evolve,” he said.
Beyond technical and clinical capabilities, Briscoe said it was important to embed cultural safety into every level of healthcare reform.
“Cultural safety is not an optional extra; it’s foundational to improving health outcomes for our people. This means recognising the value of our health workers and ensuring they have the tools and support to succeed,” he said.
Looking forward, Briscoe called on governments to work collaboratively with Indigenous organisations like NAATSIHWP to implement reforms that genuinely address the needs of Aboriginal and Torres Strait Islander communities.
“We are ready to partner with the Government to create solutions that are informed by our people and our experiences. Real change requires listening to those on the ground and investing in systems that reflect the realities of our communities,” he said.
Enablers of change
Primary Health Networks (PHNs) are set to play a central role in implementing the review’s recommendations, particularly in fostering collaboration and commissioning services that address local needs.
Learne Durrington, CEO of the WA Primary Health Alliance (WAPHA), told Croakey that PHNs are uniquely positioned to drive reform at the community level.
“Through commissioning nursing and allied health professionals, PHNs are enabling general practices to implement new care models that improve access and foster trust among multidisciplinary teams,” Durrington said.
The ability of PHNs to assess regional and local requirements makes them key enablers of reforms like blended funding models and multidisciplinary care. Durrington pointed to WAPHA’s success in developing innovative programs that integrate allied health professionals into general practices.
“We’re already seeing how embedding these roles can improve patient outcomes and create a more sustainable healthcare system,” she said.
Durrington also highlighted the importance of addressing workforce shortages in rural areas. “PHNs have a unique ability to commission targeted services where they are most needed, ensuring equity in healthcare delivery,” she said.
Durrington said consumers wanted the government to address two key areas in improving access to healthcare. However, she notes that expanding scope of practice is not a solution in itself.
“Firstly, help the current workforce safely and confidently work to their full scope of practice, so more clinicians can provide more services to people, reducing disparities in healthcare access and leading to improved healthcare outcomes.
“Secondly, consumers are very supportive of the Government to continue its workforce reforms and recruitment to help get more health practitioners into the remote areas where they are so sorely needed. Expanding scope of practice will get us part of the way there, but it isn’t the only lever government needs to pull to solve this problem for all Australia,” she said.
Next steps
The Federal Government has committed to carefully considering the review’s findings, but a definitive timeline for action remains unclear.
“This is a really important reform opportunity. It just doesn’t make sense not to use every skerrick of skills and training that all of our health professionals have,” Minister Butler said.
“This is not just about efficiency; it’s about making sure every health professional feels their skills are valued, which keeps them in the workforce longer,” he added.
Dr Elizabeth Deveny has called for the Government to engage consumers more actively in the reform process. “Consumers should have a voice at every stage, ensuring that changes align with their needs and expectations,” she said.
However, while there is ministerial enthusiasm, and a desire for change in some quarters, stakeholder divisions, funding challenges, and legislative complexities remain.
That said, the review’s emphasis on collaboration and consumer-centred care provides a strong foundation for change.
• Read the Unleashing the Potential of our Health Workforce Scope of Practice Review’s final report
See Croakey’s extensive archive of articles on health workforce matters
