Changing health professionals’ scope of practice: how do we continue to make progress?

Abstract

Executive Summary What are the issues related to health professionals’ changing scope of practice in Australia? There is evidence that the current organisation of health professionals and health practitioners, and their associated scope of practice, are not suited to meet the needs of the Australian health system. This is contributing to unsafe and inefficient care delivery. There have been substantial changes in population health needs and the technologies, structures and processes of the health care system, yet there has been little change in the health workforce to adapt to the system requirements. Many of the difficulties in adapting the workforce are created by existing legislation and regulation, the funding models for health professional services, and entrenched professional cultures. There is no agreement on coherent policy for the health workforce even though the national, state, and territory governments have focused on this issue What are the implications if these issues are not addressed? Individual health services and health systems will be unable to implement changes to their health professional and practitioner workforce that enable them to meet the access, quality and financial targets necessary for sustainable operation of the public health system. What can we do? While there have been a range of health practitioner scope of practice changes documented in the literature, there is no analytical framework to categorise the changes to enable benchmarking of achievements and outcomes. In addition, few of the scope of practice changes have been evaluated, and those that have, suffer from poor methodology and lack of economic evaluation. This suggests that there are no ready-made solutions waiting on the shelf and leads to the following recommendations. Include health professional and practitioner scope of practice as a standing item on the national, and state and territory health policy agendas, with the goal to develop national policy directions that are supported by all parties. Three actions are required to procure the data needed to enable this policy development to proceed: Establish and maintain a central repository of Australian health professional and practitioner scopes of practice. Develop inter-disciplinary agreement on essential work roles in community and primary care, mental health, aged and chronic care and Aboriginal and Torres Strait Islander health. Prioritise health services research directed to evaluation of changes in health professional and health practitioner scope of practice. Once the policy has been developed, undertake legislative changes to facilitate scope of practice changes, amend health service purchasing rules to encourage safe service delivery by a broader range of health professionals, and reform health professional education to better address the workforce needs of the health system. These changes will be required to support health workforce policy that encourages a flexible approach to health practitioner scope of practice, but that still ensures sufficient protection for the population.