newsGP - Scope review creating ‘McMedicine’: RACGP President (2024)

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Australia’s healthcare system is heading in a dire direction, with fears a new review will leave the already fragile sector fractured, broken, and ‘bad for people’s health’.

That is according to RACGP President Dr Nicole Higgins, who has taken a strong position against findings in the Scope of Practice Review’s second issues paper.

The paper, released on Wednesday, proposes eight policy reform options across three themes – workforce design, development and planning; legislation and regulation; and funding and payment policy.

Summarising the challenges faced by primary healthcare professionals, the review highlighted that doctors’ skills are currently poorly recognised, there is a lack of exposure to primary care for medical students, and legislation is impeding doctors working to their full scope.

It also noted several barriers and their tangible impacts, including reduced skills portability, poor workforce retention, inadequate patient access to care in regional areas, high GP workloads, and reduced opportunity for multidisciplinary care.

However, the college is concerned about the paper’s continuous mentioning of primary care teams, despite being vague about whether that definition includes GPs.

Dr Higgins said the paper has left her feeling ‘angry and devalued’ as it appears to confirm fears about a future of task substitution and oversimplified general practice.

‘They’ve reduced medicine, they’ve reduced healthcare, to tasks and activities versus looking at the outcomes and how those outcomes are achieved,’ she told newsGP.

‘We can’t have a system that is fractured and broken into pieces, where everyone has access to the MBS and the PBS at huge costs to the taxpayer.

‘We could end up with a fragmented, inefficient healthcare system that doesn’t share information, that’s bad for people’s health, and where the onus is going to be on the patient to ask, “are you trained to treat me?”.’

Instead, the RACGP says the solution to improving access and reducing costs for patients lies in supporting more GPs to train and work in communities.

The issues paper calls for the establishment of a national skills and capability matrix, intended to clarify the abilities of all healthcare professionals.

Specifically, it calls for the development of a combined skills and capability framework, highlighting areas of shared scope and common capability and a national scope definition.

It also recommends bolstering early career and ongoing professional development, including multi-professional learnings, and national consistency in post-qualification education and training.

Other priorities include an assessment of laws and the removal of legislative barriers currently ‘restricting’ healthcare professionals from practising to their full scope, and a risk-based approach to regulating scope of practice around certain higher-risk activities.

Finally, it suggests funding and payment models to incentivise multidisciplinary care teams to work to ‘full scope of practice’, and direct referral pathways, supported by technology, to improve patient referrals.

The paper’s reform options include using block, bundled and blended funding to deliver care flexibly, complementary to fee-for-service, and a single payment rate for specified activities falling within overlapping scope.

The college says funding must be flexible and fee-for-service retained so GPs can best respond to their patients’ needs, as well as calling on the Government to commit to no capitation.

It is also advocating caution around any unintended consequences of reforms that seek to ‘cash out’ on current incentives, which are critical to the viability of general practice in delivering high-quality care.

Dr Higgins said the review has ‘completely failed to acknowledge the training, the skills, and the role GPs play in primary healthcare’.

‘General practice can’t stand by and watch our health system be reduced to McMedicine – we can’t trade off quality and safety for convenience,’ she said.

‘It takes 11 years of training to be a GP which is very different to three years of training to become a nurse – we all have our skills and our strengths, but they’re different.’

It comes as the RACGP fears Australia’s health system is heading in the direction of the UK, where lesser-trained health professionals have missed life-threatening diagnoses.

A paperfrom public health thinktank The King’s Fund recently described the lack of primary care investment as one of the NHS’s most significant and long-running policy failures, resulting in hundreds of UK-trained doctors fleeing to Australia.

Dr Higgins is now urging GPs to knock on their local politician’s door and call for change.

‘I’ve already told [Federal Health and Aged Care Minister] Mark Butler that there will be 40,000 angry GPs talking with their local Member of Parliament about what this will do to general practice,’ she said.

‘It’s important that people remember that this is just a review, and reviews aren’t necessarily implemented, and if there are recommendations, they take time.’

The review was a priority recommendation of theStrengthening Medicare Taskforce Report, aimed at allowing health professionals to work to their full potential, while emphasising the need for multidisciplinary teams.

Its initial Issues Paper, released earlier this year, also clearly expressed the need for a different funding model and better coordination between specialties.

The RACGP is now seeking member feedback on the review as it begins to create its next submission.

A third phase of consultation on the review will be undertaken between July and September, before a final report is submitted to the Commonwealth in October.

­Log in below to join the consultation.

general practice general practice reform Scope of Practice task substitution