In the latest proposals to optimise the health workforce, Optometry Australia (OA) has welcomed a national matrix that clearly sets out the skills and capabilities of health professionals, regardless of whether they are regulated, and the establishment of an independent body to oversee how scope-of-practice changes are rolled out.
The peak body has responded to Issues Paper 2 of the Scope of Practice Review that is assessing the barriers preventing Australia’s healthcare practitioners from working to the full extent of their skills and training to deliver best practice primary care.
In October 2023, Optometry Australia provided initial feedback, stating the profession faced “various funding, regulatory, technological, cultural, and inter-professional barriers” preventing them from practising to their fullest scope. It also called for a detailed comparison of health professionals in other countries to identify opportunities for further scope enhancements and highlighted examples of health systems where prescribing of oral medications and intravitreal injections – which Australian optometrists are prohibited from performing – are performed by non-ophthalmologists.
It also wants to see greater use of collaborative care models – already established in parts of the country – but pointed out scalability remains a hurdle.
So far, the Scope of Practice review has been through two rounds of consultations, receiving close to 1,000 submissions and involving many face-to-face meetings. Issues Paper 2 outlines findings from the second round of consultations and presents eight key recommendations for reform.
After reviewing the document, OA said it welcomed a proposed national skills and capability framework and matrix that sets out the skills and capabilities of health professionals, including members of regulated, self-regulated and unregulated professions.
According to the government, this would contribute to better recognition of health professional skills and strengthen the system by informing workforce planning. This reform is considered “foundational for all remaining reform options and integral to facilitating health professionals to work to their full scope-of-practice”.
OA said: “This initiative will greatly assist with implementing and coordinating multidisciplinary care programs. To further assist with its utility, we strongly advocate for the matrix to includes the capabilities of the top of scope of the professions. Following on from this, the matrix should be regularly updated to keep pace with advancements in technology and practice.”
There’s also a proposal to create a new independent body tasked with identifying and implementing emerging best practice evidence into primary health workforce models.
The entity would be responsible for providing advice to governments and regulators on how the various scopes for health professionals can continue to meet community need. This body would also factor in the role of new technology, new roles and new workforce models, and the impact of combined scopes of practice – both overlapping and distinct – of certain professions. It would exist as an independent advisory committee, either as a newly formed autonomous national body or sitting under the remit of a body like the Australian Health Practitioner Regulation Agency (Ahpra). It would act like the Medical Services Advisory Committee (MSAC) or Pharmaceutical Benefits Advisory Committee (PBAC).
“We support an independent body approach to regulating scope-of-practice,” OA said. “This body could be tasked with providing assistance to registration boards to assist with progressing change thereby focusing on scope-of-practice reforms.”
In addition, OA called for simplified legislation for prescribing rights. “This will enable ongoing refinements to be agile and facilitate the utility of the national skills and capability matrix.”
With respect to enhanced inter-professional collaboration, OA said the Scope of Practice Review provided some excellent initiatives for primary care.
“However, it needs further focus on inter-professional collaboration between primary, secondary, and tertiary care to decrease the load on tertiary care. In particular this should include funding models of collaborative care and asynchronous (store and forward) telehealth.”
Restrictive funding models
The review, led by Australian National University health workforce expert Professor Mark Cormack, outlined the biggest challenges facing the workforce.
In Issues Paper 2, it found legislation impedes health professionals working to their full scope. Where the law dictates which professions are authorised to provide a service, other health professions who may have the same skill are unable to do so. At times, legislation does not keep up with accepted changes in practice. There are also differences between state and territory legislation.
“Funding and payment arrangements impede health professionals working to their full scope.
“Existing funding models restrict some professions from working to their full scope-of-practice and fail to adequately support primary care health professionals to work together in teams,” the report said.
With this, it said there was reduced workforce mobility and skills portability, resulting from inconsistent recognition of professional scope and qualifications. Poor workforce retention, due to scope limitations, was identified as a strong influence on health professionals choosing to leave the health workforce.
“[There is] restricted consumer access to optimal care, particularly for consumers living in regional and remote areas. This was highlighted where a health professional is available, but not authorised or enabled to provide care that falls within their scope,” the report said.
“[There is also] reduced opportunity for multidisciplinary care, due to barriers restricting health professionals from working collaboratively as a multidisciplinary team and reinforcing professional siloes.”
The review is being conducted in four phases with a final report and implementation plans expected by October 2024.
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