The Scope of Practice Review, risk factors for falls among people with dementia, and the benefits of fee-free TAFE courses for the health and social workforces are among some of the topics addressed in this week’s column.
Don’t miss the global health updates, and our columnist’s incisive commentary on the Pharmacy Guild raising concerns about the merger between Sigma Healthcare Limited and CW Group Holdings Limited (Chemist Warehouse).
This week, we couldn’t decide between two pithy quotes, so there are two.
The quotables?
The elephant in the room is that there simply is not enough funding available to primary care to deliver the level of service that is needed.”
And…
Australia’s aged care system will continue to operate under an inadequate statutory framework that fails to provide timely access to high quality care for vulnerable older people.”
Charles Maskell-Knight writes:
The report of the Scope of Practice Review carried out by Professor Mark Cormack was presented to the Government on 30 October and released by Health Minister Mark Butler on 5 November.
According to Butler, the Review found that “virtually all the nation’s health professions face restrictions and barriers in working to their fullest – restrictions that are unrelated to their skills, training and experience”.
Further, “removing these barriers would make it easier for Australians to get high quality care, when and where they need it, without waiting weeks for an appointment. This is particularly the case in regional and remote areas”.
The Review made 18 recommendations across four broad themes. The recommendations included:
- establishing a primary care workforce development program
- removing unnecessary barriers to supervision in primary care education and training
- introducing a new blended payment to enable access to multidisciplinary healthcare delivered by health professionals working to their full scope of practice in primary care, which would be supported by a significant growth in spending and which would shift the mix of Australian Government payments for primary care from a 90:10 fee-for-service: blended payment to 60:40
- allowing allied health practitioners to refer directly to medical specialists in some circumstances
- developing a shared definition of cultural safety across primary care
- mandating participation by all primary care providers in an accreditation program.
The Review also recommended that Governments should commit to prioritising implementation of the reforms in rural, remote and underserviced areas.
Butler said that the Government would “carefully consider the findings and recommendations of the Review alongside other primary health care and workforce review reports”.
Professor Stephen Duckett AM discussed the implications of the Review in The Conversation, concluding that it “charts a middle course between letting health professionals roam free and the tight and inappropriate rules and regulations which constrain patient care today”.
Croakey colleague Jason Staines also wrote about the Review.
Non-medical health sector organisations supporting the Review’s recommendations included Advanced Pharmacy Australia, Allied Health Professions Australia, the Australian College of Nursing, the Australian College of Paramedicine, the Australian Nursing and Midwifery Federation, the Australian Physiotherapy Association, Dietitians Australia, the National Rural Health Alliance, the Pharmaceutical Society of Australia, and Private Healthcare Australia.
Medical groups were notably less enthusiastic.
The Royal Australian College of GPs urged the Government “to exercise caution in its assessment of the recommendations”, and said that some of the recommendations “may sound good on the surface but will result in a costlier health system, more delays to care, and higher out-of-pocket costs for patients”.
The RACGP said it was “particularly concerned about the proposal to open direct referral pathways to more health professionals”.
However, President Dr Nicole Higgins gave “cautious support” to a well-implemented “blended payment model that continues to support fee for service [and] would give general practices more flexibility to employ or engage different health professionals in a multidisciplinary care team”.
The Australian Medical Association (AMA) was also sceptical, with President Dr Danielle McMullen saying “the report contained some positive ideas, but many of the recommendations appeared to suggest Australia should adopt an NHS-style approach that has doomed primary care in the UK”.
McMullen called on the Government to work to build the GP workforce, and not implement “Band-Aid solutions”.
I’m not sure people facing delays in accessing primary care now can wait for additional GPs to complete a decade-long education and training pathway.
The Australian College of Rural and Remote Medicine (ACRRM) said the Review “missed the mark on rural and remote community need”, and that some recommendations “may undermine access to high-quality, continuous, and coordinated care in rural, remote, and First Nations communities”.
ACRRM President Dr Rod Martin said that “opening up unrestricted access to all health professions without coordination risks fragmenting care, which could harm patient outcomes in these communities”.
While this may be true, the Review does not actually recommend “opening up unrestricted access to all health professions without coordination”.
The Rural Doctors Association of Australia was somewhat more positive, but made the point that a viable solution for improved access to health services in rural areas needed a comprehensive approach based on the other three reviews released recently as well as the Scope of Practice Review.
RDAA President Dr RT Lewandowski said “the elephant in the room is that there simply is not enough funding available to primary care to deliver the level of service that is needed”.
“Throughout the many consultation meetings and workshops RDAA has attended over the past 18 months, all have featured feedback that additional funding is needed; however, the focus from all the reports seems to be on moving the current funding around,” Lewandowski said.
The Primary Care Business Council (representing corporate general practice) also expressed caution.
Ministers and government
Minister Butler issued a media release marking the one-year anniversary of the increase in GP bilk billing incentives.
He said that the data showed the increase had “revived bulk billing and created an additional 103,000 bulk billed visits to the GP every week, on average, or 5.4 million additional bulk billed visits since November last year”.
He said 77.3 percent of all GP visits were bulk billed in October 2024, an increase of 1.7 percentage points on the same month last year.
Following an announcement by the Pharmaceutical Benefits Advisory Committee (PBAC) meeting last week that some submissions would need to be deferred from the March 2025 meeting to the July meeting, Minister Butler intervened to direct PBAC to hold an additional full meeting in May 2025. The decision was welcomed by Medicines Australia.
The Australian Institute of Health and Welfare (AIHW) issued a report on First hospitalised falls among people living with dementia: risk factors and outcomes. The report concluded that “people living with dementia are more likely to experience falls and severe outcomes following a fall than people without dementia”.
It found that the most important risk factors for falls for people living with dementia in the community were balance issues and nervous system drugs, while for people living in residential aged care, risk factors were agitation and drugs for depression.
The AIHW released new data for the period 2020–21 to 2022–23 on Alcohol available for consumption (previously called Apparent consumption of alcohol), which measures “the total amount of alcohol either produced in Australia or imported into Australia, that will be sold to people living in Australia”.
The data show an increase from 10.04 litres of pure alcohol per capita in 2019-20 to 10.85 litres in 2020-21. Since then the amount has fallen to 10.46, still higher than any year since 2009-10.
The AIHW also released the latest Pharmaceutical Benefit Scheme monthly data.
The Australian Medical Research Advisory Board determined the Australian Medical Research and Innovation Priorities, which will inform government decisions on Medical Research Future Fund (MRFF) investments for the next two years. The major departure from the previous set of priorities was the removal of the Antimicrobial Resistance priority, which is now subsumed in the Global Health and Health Security priority.
Professor Anthony Scott from Monash University noted that “the new MRFF priorities again fail to consider research on the health system, its financing, incentives and health workforce”.
“This stuff needs to be tackled head on and not buried within the usual MRFF disease and sector specific silos,” he said. “It influences the success of all of the priorities.”
The Australian Competition and Consumer Commission (ACCC) announced it would not oppose the merger between Sigma Healthcare Limited and CW Group Holdings Limited (Chemist Warehouse), after accepting a court-enforceable undertaking from Sigma.
Chair Gina Cass-Gottlieb said “the ACCC’s analysis found that the proposed merger is unlikely to substantially lessen competition nationally or locally because other pharmacies and non-pharmacy retailers will continue to compete to the same extent they compete now”.
The Pharmacy Guild issued a statement “noting” the decision, and commenting that “a reduction in wholesaling choices for community pharmacy is a substantial reduction, which will lessen competition”.
“Reduced competition ultimately leads to higher prices for patients and lower service standards.”
As its members are beneficiaries of the fundamentally anti-competitive pharmacy ownership and location regulatory regime, the Guild is an expert on the effects of reduced competition.
First Nations health
The Conversation published an article by Ray Kelly and Professor Margaret Morris based on research presented in The Medical Journal of Australia on diabetes affecting First Nations people and the role of exercise preventing or managing the disease.
The data show that First Nations people are three times as likely to be diagnosed with diabetes as the general population, and over four times as likely to die of the disease. Research has also demonstrated that physical activity plays an important role in the prevention and management of the disease.
However, there is a dearth of research on “physical activity interventions for preventing or managing diabetes in Indigenous adults”.
The authors conclude that “given physical activity is a cornerstone in the management of type 2 diabetes, we need more rigorous research in this area”.
“These studies must be well designed and culturally appropriate [and] involve Aboriginal and Torres Strait Islander people at all levels of the research process.”
Consumer and public health groups
National Seniors Australia (NSA) issued a statement on the “latest data showing people applying for a Home Care Package could be waiting up to 15 months before they receive a package at the level they need”.
NSA CEO Chris Grice said “as the Royal Commission heard all those years ago, people were receiving approvals for care long after they were assessed, in some instances they died waiting”.
“Everyone agreed it shouldn’t happen but here we are again, having the same conversation, about the same situation”.
There is no requirement in the Aged Care Bill currently before the Parliament for people to have timely access to services.
The Older Persons Advocacy Network (OPAN) released National Aged Care Advocacy Program – Presenting Issues Report for 2023-24, providing a detailed analysis of the more than 44,000 “instances of information and advocacy support” provided to older people and their families.
The report found that “poor communication, lack of choice and control and issues around fees and charges were the key challenges for the third year in a row”.
“Workforce shortages, along with provider approaches to implementing changes to the Social, Community Home Care and Disability Services Industry Award, also continued to have a major impact on consistent and reliable service delivery in 2023–24,” it said.
Trade unions
The AMA acknowledged the release of the Private Hospital Sector Financial Health Check and Minister Butler’s announcement of the Private Health CEO Forum to include “leaders from private hospitals, private health insurers, medical groups and independent experts”.
AMA Vice President and private specialist Associate Professor Julian Rait said “the AMA has long been calling for a stakeholder-led reform body as part of our advocacy for an independent Private Health System Authority”.
The ANMF welcomed the Government’s commitment to continue and expand fee-free TAFE courses. Federal Secretary Annie Butler said the commitment would “help address skills shortages in the nursing and aged care workforces and save students thousands of dollars a year in TAFE course fees”.
She added that the ANMF was “delighted that so far, over 300,000 women have enrolled in fee-free courses across various sectors, including nursing, aged care and disability services”.
The Council of Presidents of Medical Colleges (CPMC) issued a statement warning that fast-tracking International Medical Graduate registration alone will not solve Australia’s rural healthcare challenges.
It said that “without proper planning, new specialists may concentrate in urban areas while regional communities continue to face specialist shortages”.
Associate Professor Sanjay Jeganathan, Chair of CPMC, said “regional Australians deserve the same quality healthcare as city residents, yet the current approach risks widening rather than closing these geographical healthcare gaps”.
However, the CPMC statement did not suggest a mechanism to close the gaps.
The RACGP welcomed the new Queensland Government’s decision to remove payroll tax from GPs, and called on other jurisdictions to do the same.
The Royal Australasian College of Surgeons commented on the Healthscope private hospital co-payment issue, “urging all parties to return to the negotiating table [and] resume negotiations in good faith and find an agreement that balances the needs of patients, surgeons, and healthcare providers, while recognising the increasing costs of delivering quality surgical care”.
The RDAA reported that some large regional hospitals and tertiary health services are charging rural doctors a significant fee to participate in skills maintenance programs.
RDAA President Dr RT Lewandowski said the emerging trend of charging for skills maintenance has been identified across multiple sites and “needs to stop now”.
He called on “state health ministers to immediately address this issue and ensure that rural doctors participating in any skills maintenance program provided by their regional health service are able to do so free of charge”.
Politicians and parliamentary committees
The Senate inquiry into the Aged Care Bill released its report, with the majority of Government senators recommending the bill be passed.
The majority report said that “the committee is of the view that the bill meaningfully responds to the findings of the Aged Care Royal Commission”.
I’m not sure what “meaningfully responds” means, but the bill actually ignores many key recommendations from the Royal Commission.
For example, the Royal Commission recommended that the new Act should have as an object the provision of high quality care. The bill does not include this.
The Royal Commission recommended that providers should have a duty to deliver high quality care. The bill does not include this: it only imposes a duty on providers to “demonstrate the capability for, and commitment to, continuous improvement towards the delivery of high quality care”.
The Office of the Inspector General of Aged Care told the Senate inquiry that “the Royal Commission called for a paradigm shift to the architectural foundations of Australia’s aged care system, which is premised on access to care being rationed”.
“Royal Commissioners recommended a new seamless aged care program be established, with access to care a universal entitlement based on an assessed need, coupled with certainty of funding …
“The Bill, however, retains the rationed approach that has always been a feature of Australia’s aged care system”.
In many other important areas the bill ignores the Royal Commission’s recommendations.
In their comments Coalition senators also recommended the bill be passed, but made 31 other recommendations, many relating to concerns raised by aged care providers.
Senator David Pocock raised a number of issues, and concluded he looked forward to working to “ensure sensible amendments are adopted by the Senate” as the bill proceeds.
The Greens dissenting report identified many issues raised by older persons, including lived experience witnesses, and aged care advocates.
It concluded that “the key driver for aged care reform was never meant to be ‘budget repair’ or provider profitability, it was the urgent need to improve care, quality and enforcement in the sector after the shocking revelations of the Royal Commission”.
“Every person fortunate enough to live into old age will need to be cared for. If this really is the once-in-a-generation opportunity for reform, then it is critical that we get it right”.
The Greens recommended that “the Government address many of the serious concerns raised throughout the inquiry”.
Unfortunately, there is no indication that the Government – or the Opposition – will heed any of these concerns.
Australia’s aged care system will continue to operate under an inadequate statutory framework that fails to provide timely access to high quality care for vulnerable older people.
International
The major international story affecting health was the election of Donald Trump for a second term as US President. Croakey has covered the implications for health and environmental policy in a number of articles here, here and here.
In other international news, the World Health Organization (WHO) published a study naming 17 pathogens as top priorities for new vaccine development.
The WHO said the study was “the first global effort to systematically prioritize endemic pathogens based on criteria that included regional disease burden, antimicrobial resistance risk and socioeconomic impact”.
The list included pathogens where vaccine research is needed (Group A streptococcus, Hepatitis C virus, HIV-1, and Klebsiella pneumoniae); pathogens where vaccines need to be further developed (Cytomegalovirus, Influenza virus (broadly protective vaccine), Leishmania species, Non-typhoidal Salmonella, Norovirus, Plasmodium falciparum (malaria), Shigella species, and Staphylococcus aureus); and pathogens where vaccines are approaching regulatory approval, policy recommendation or introduction (Dengue virus, Group B streptococcus, Extra-intestinal pathogenic E. coli, Mycobacterium tuberculosis, and Respiratory syncytial virus (RSV)).
Finally
One of the many scary aspects of Donald Trump’s victory in the US election is the suggestion that noted vaccine sceptic and fluoride opponent Robert F Kennedy Jr will have some sort of oversight role of health and food regulation.
In the aftermath of the election Kennedy sought to reassure the public, telling NPR “we’re not going to take vaccines away from anybody”.
“We are going to make sure that Americans have good information right now,” he said. “The science on vaccine safety, particularly has huge deficits and we’re going to make sure those scientific studies are done and that people can make informed choices about their vaccinations and their children’s vaccinations.”
Somehow, I don’t feel reassured.
CDC data show that just under 70 percent of American children aged 24 months have completed all seven sets of recommended childhood vaccinations, and I can’t see a program of “scientific studies” curated by an agency overseen by Kennedy improving the situation.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
https://consultations.health.gov.au/
Consultations | Therapeutic Goods Administration (TGA)
NHMRC consultation hub – Citizen Space
Public consultations | Food Standards Australia New Zealand
Department of Health and Aged Care
Reforms to strengthen the National Mental Health Commission and National Suicide Prevention Office
11 November
Free TV Australia
Revised Commercial Television Industry Code of Practice
11 November
Therapeutic Goods Administration
Medical Devices – Essential Principles for Safety and Performance
13 November (extended from 16 October)
Independent Health and Aged Care Pricing Authority
NDIS pricing reform
15 November
Department of Health and Aged Care
Potential reforms to the Medicare safety net
15 November
Australian Commission on Safety and Quality in Health Care
Updated Falls Guidelines Consultation
20 November
Office of the Gene Technology Regulator
Online Services Portal Survey
22 November
National Health and Medical Research Council
Updated Australian Drinking Water Guidelines
22 November
National Health and Medical Research Council
Proposed updates to the Investigator and Synergy Grant assessment framework
4 December
Department of Health and Aged Care
Medical Research Future Fund Australian Brain Cancer Mission – consultation on the refreshed Roadmap and Implementation Plan
20 December
House of Representatives Standing Committee on Health, Aged Care and Sport
Inquiry into the health impacts of alcohol and other drugs in Australia
31 December
Therapeutic Goods Administration
Medicine shortages and discontinuations – reportable medicines and timeframes for reporting discontinuations
13 January 2025
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK.
Bookmark this link to follow The Zap
