Why is this useful for rural and remote people?

Primary health care in rural and remote communities traditionally relied on a local GP delivering a comprehensive range of health care services from a local general practice. GPs were also typically paid by the local rural hospital to be on-call to triage and stabilise emergency and acute patients at the local hospital as a Visiting Medical Officer until the patient could be transported to a larger hospital facility by air or road. This model worked well in the past, but the decline in the number of rural GPs, an ageing population and the growing rates of chronic disease has made this model unsustainable. Part of the reason for the decline in rural GPs was the decision by the general practice industry to move from a focus on being generalists (general experts in the diagnosis of disease and injury, and treatment) to specialists (experts in differential diagnosis and treatment planning). This shift had two implications: (1) GPs today lack the same multidisciplinary (generalist) skills possessed by GPs in the past, and which are necessary for successful practice in rural and remote communities; and (2) medical students increasingly choose to enter other specialties today because other specialities are more highly paid, and specialists have greater control over their work/life balance. The decision to re-fashion general practice as a speciality has led to a rapid decline in the proportion of medical graduates wanting to work as a GP. The number has declined from around 40% of all medical graduates to 13% in 2022. As GPs moved from generalism to specialism, other health professions expanded their scope of practice to fill the gaps. The role of Nurse Practitioner, for example, provided a pathway for nurses to upskill to perform a range of clinical functions once performed by GPs. At the same time, the academic preparation and training of allied health professionals increased to enable these health practitioners to provide a range of treatment services at a very high level of expertise. As the clinical skills and training of other health professions increased, GPs began referring patients to these health professionals for treatment. However, health regulation and funding system failed to keep up with these changes. Medicare continues to operate on the assumption that GPs are the only professionals capable of providing both diagnosis and treatment of patients in general practice. The Scope of Practice Review is an important opportunity to modernise and harmonise health regulation and funding. This is critically important in rural and remote areas. Both rural and metropolitan areas are increasingly feeling the effects of the decline in the number of old-fashioned GPs. While many of the clinical functions once performed by GPs can now be performed by other highly trained health professionals, these practitioners are restricted from accessing funding to deliver these services in rural and remote towns. For example, while a local Nurse Practitioner or Registered Nurse who lives in a rural or remote town is educated and trained to perform many of the functions once performed by a GP, the antiquated Medicare rules means that this local person cannot get funding to provide care to the full scope of their professional practice in their own community. This often means that the community goes without services it could otherwise receive, or the person leaves rural Australia to work in a city. The Scope of Practice Review is perhaps the single most important policy reform to date that has the potential to transform access to health care in rural and remote towns in the future. Engaging with this review is critical for rural and remote communities concerned with the sustainable and high quality health care in their communities.