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GPs advocate for change at Scope of Practice roadshow


Michelle Wisbey


13/02/2024 2:28:15 PM

GPs have left a lasting impression on decisionmakers, as those responsible for the reforms embark on a nationwide tour to hear directly from medical professionals.

Mark Cormack standing next to Cathryn Hester.
RACGP Queensland Chair Dr Cathryn Hester with Professor Mark Cormack at the roadshow’s Brisbane stop.

Multidisciplinary care, competency standards, and training support were among the changes called for by GPs, as the Scope of Practice review hits the road.
 
As part of the landmark review, independent lead Professor Mark Cormack and his team are visiting every state and territory this month, with the aim of hearing directly from healthcare workers.
 
Aa priority recommendation of the Strengthening Medicare Taskforce Report, the review is aimed at ensuring all healthcare professionals are working to their full potential.
 
The roadshow has already visited Canberra, Sydney, Brisbane, and Melbourne, and will continue to Tasmania, Adelaide, Perth, and Darwin later this month.
 
And GPs have made sure to make their voices heard at the events so far.
 
Beginning in Canberra, Registrar Dr Betty Ge spoke about the need for national uniform legislation, to ensure all healthcare professionals are working towards same rules to allow for optimal patient care.
 
She also called for increased primary care funding, especially for complex patients, better support to complete training, and a digital overhaul to allow for patient information to be better synchronised.
 
In Sydney, Dr Kim Loo spoke about the multidisciplinary practice she works in, which has a large team of GPs and nurses, and Primary Health Network funding for a psychiatrist, a peer support worker, and pharmacists to help with complex patients, as well as telehealth diabetes care.
 
Her advocacy for this wrap-around service for patients impressed Professor Cormack, earning it a mention in his overview of the day.
 
RACGP Queensland Chair Dr Cathryn Hester participated in the Brisbane event and spoke about fragmentation of care and continuity of care, as well as GPs’ capabilities.
 
‘This is a really good opportunity for us to be able to do the things that we’re well and truly capable of,’ she told newsGP.
 
‘The obvious place to start is with the things that clinicians are already trained and capable of and safe to perform, and a good example of that is GPs being able to prescribe oral retinoids.
 
‘But I think it’s also a little bit of a double-edged sword in that we can definitely make some gains for the GPs’ scope of practice, but I don’t want to see our continuity of care and relationship with a patient impaired.’
 
Dr Hester shared a table at the roadshow with several different professional representatives, including pharmacists, nurses, and Australian Genomics.
 
She said while each group has different roles, many of their advocacy calls shared similarities.
 
‘The interesting thing was that at the table, despite our diverse professional backgrounds, we’re often very much in agreement,’ Dr Hester said.
 
‘Our values and goals are actually very, very similar, so I found we actually had surprisingly good alignment with other health professional groups.
 
‘I’d like to see [more] digital tools to make it a little bit easier to coordinate care between different ancillary providers, and also a greater visibility over the care that other providers are offering patients.’
 
The roadshow comes after the review’s initial Issues Paper was released last month, laying bare the need for a different funding model and better coordination between specialties.
 
The eight roundtable events have been designed as an opportunity for key stakeholders to come together, comment on the Issues Paper, and advise and shape the next steps of the review.
 
That paper highlighted the benefit of a ‘highly functional, collaborative interprofessional team’, as well as the need for better access to funding for health professionals.
 
It also expressed concern that primary healthcare workers would leave the profession if lower reimbursement rates do not improve.
 
RACGP President Dr Nicole Higgins told newsGP the roadshow follows significant RACGP consultation with members, finding an overwhelming majority of GPs believe they can increase their scope of practice.
 
‘This is an opportunity for GPs to contribute and tell their stories around what it means for them on the ground,’ she said.
 
‘What people might not realise is that the Scope of Practice review is looking at the legislative and regulatory frameworks, it’s not looking at the tasks of each individual profession.
 
‘For GPs, going to the roadshows and being able to tell their stories, these narratives will drive policy and strengthen the position of general practice as the cornerstone of primary care.’
 
However, Dr Higgins said she still has concerns over the review and its outcomes.
 
‘Governments don’t call for reviews unless they have a particular idea about the outcome that they are seeking,’ she said.
 
‘My concern is that the discussion around access has been driving the conversation, but we need to balance that with quality, safety, cost to the taxpayer, and the changes that may arise.
 
‘We need to make sure that we don’t have open slather, which will have a huge impact on the budget and potentially the health and wellbeing of Australians.’
 
The review’s final report and implementation plan is due to be handed to the Department of Health and Aged Care in October.
 
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Dr Gideon Johannes Gouws   14/02/2024 7:22:31 AM

As government has signalled, the primary objective of the review is to make primary care more accessible. Expect to see allied health, nursing and pharmacy etc. take on roles previously considered the domain of general practice. Expect to see very limited increment of scope at the upper end of general practice, abutting other specialist and sub-specialist care. Beware, GP's may find themselves in a tightening sandwich.


Dr Brendan Sean Chaston   14/02/2024 9:39:12 AM

For mine this roadshow is akin to a Trojan Horse entering the city of ‘General Practice’. It’s all about broadening the ‘scope of practice’ of various Allied Health groups into areas traditionally managed by GP’s. Essentially a systemic extension of the ‘pharmacy prescribing’ concept but this time without the pretence of a ‘trial’. I’m surprised these’s not greater push back from the college. Not doubt it’s a preordained decision anyway.


Dr Edward Thomas Wu   14/02/2024 12:11:56 PM

‘Governments don’t call for reviews unless they have a particular idea about the outcome that they are seeking’. Under this setting, how can a government appointee be consider "independent"? Looking at this setup carefully, Professor Mark Cormack has an academic/bureaucratic background and an appointee by politicians with no personal experience in "care" provision at the interface of humanity - the historical origin and origin of health/medical practice. This exercise is just another demarcation bargaining of "stake holders". The "people needing care" will ultimately the only losers under the rigid "legislative" and "regulatory" might of politics.


Dr Angela Maree Roche   14/02/2024 1:07:15 PM

There is no guarantee that “ multidisciplinary teams” will be, in practice, “ highly functional “ and “ collaborative “. In fact there is certainly the risk , as Dr Hester alluded to , of impairment of continuity of care and potential harm to the GP doctor patient relationship, which is really at the heart of what general practice is and what has differentiated general practice from many other specialities and allied health


A.Prof Christopher David Hogan   14/02/2024 10:27:23 PM

To expand the scope of practice it is first necessary to describe what GPs actually do. It is amazing complex as GPs deal with complexity & uncertainty as they manage whole person care for individuals & families.
As described in https://www1.racgp.org.au/.../a-sustainable-vision-for...
https://www1.racgp.org.au/ajgp/2023/march/a-sustainable-vision-for-general-practice-1
Also GPs tend to adapt their roles to meet the needs of their patients & their community withthe resources that are available.


A.Prof Christopher David Hogan   14/02/2024 10:41:48 PM

I have worked with multidisciplinary teams MDTs in a variety of clinical settings for most of my career. They are incredibly useful & very productive when done well.
They do not happen spontaneously nor continue spontaneously.
They are complex.
All involved need specific training in how to use & run them.
Those involved need funded protected time to undertake the significant paperwork & communication they generate.


Dr Partha Sarothi Modak   17/02/2024 12:30:22 PM

When the Government wants all health professionals to work to their full potential that will allow greater accessibility of primary care, practically meaning allowing allied health professionals to do some of our GP jobs and the fact that they have both the legislative and executive power to do it, no matter what we say it will happen.
What we need to do though is protect ourselves from being embroiled into the catastrophe that I expect to see in missing diagnoses and their consequences. I want to see a general practice-wide consensus that any such presentation by a patient who has earlier seen an allied health professional should have been seen by a GP but did not, automatically get triaged to needing a specialist/ hospital review if it's medical as opposed to physio/ OT type issue. We need to ensure that those cases cannot be redirected to a GP.