Why is this useful for rural and remote people?

Over the last two decades the education and training of health professionals has changed markedly. In the past general practitioners were trained as the frontline of our health and hospital care system, diagnosing disease and providing treatment in the local community. Over the last two decades however the education and training of general practitioners has shifted to support them to become specialists in advanced differential diagnosis (applying their expert knowledge of medicine to determine the root cause of a disease or injury and prepare a treatment plan to support recovery and management). As Australia's general practice workforce specialised, the education and training of other health professionals changed to fill the gaps that were emerging in general practice. New roles such as Nurse Practitioner were established, and educational and training programs designed to enable these professionals to assume many of the functions previously performed by GPs in the community. In other countries these positions are sometimes called Assistant Physicians or Assistant Doctors and are the main providers of healthcare services in rural and remote health. The Australian health system is now well behind most other advanced countries in permitting health professionals to practice based on their qualifications and competency, rather than their title. Similarly, the education and training of Registered Nurses, Pharmacists, Optometrists, Dentists and other health professionals also expanded to incorporate functions that were once performed by a GP such as prescribing (e.g. a dentist prescribing antibiotics for a tooth related infection). There was also a rapid increase in the number of graduates in allied health disciplines that received advanced training in specialist aspects of patient treatment. For example, a physiotherapist completes at least 4 years of advanced study in the treatment of problems associated with human muscles and bones, while pharmacists complete at least 4 years of study in pharmacology. These health professionals are highly educated and trained in patient treatment, and well-equipped to provide high quality care. This does not mean a pharmacist or physiotherapist can replace a GP, but it does mean that they can provide treatment to patients with a much higher degree of specialist knowledge and skills. The Scope of Practice Review is looking at how to better deploy these health professionals to increase access for patients to high quality treatment services, while helping GPs to focus on their new roles as specialists in diagnostics and treatment planning. This is not about replacing GPs, but rather helping GPs to focus on the specialist role that they are now trained for. This potential shift has significant implications for how health and medical care will be delivered to Australians, particularly rural and remote people. As GP workforce shortages continue, and there has been a decline in the number of GPs wanting to treat patients in bricks and mortar practices or visiting residential aged care facilities, there are new opportunities for rural and remote towns to build health teams that are focussed on growing the capacity for local treatment, with GPs performing a more specialist diagnostic and planning roles for which they are trained (in some cases remotely). In the past if a GP left town then the practice would close and the town would lose their health services forever because the GP was both the expert in diagnosis and treatment. Today, there are myriad other health professionals that are qualified and skilled in treatment enabling rural and remote towns to sustain high quality health care (even in the absence of a GP) built around a team of accredited health professional. The biggest challenge for rural and remote communities, however, has been that Medicare has failed to keep up with the changes in the scope of practice that have occurred over the last two decades. While a registered nurse is trained and qualified to perform a wide range of medical services, they cannot claim a Medicare item on the same terms as a GP because the system is still built around GPs. Rural and remote towns are losing their local community health services unnecessarily because our health funding system is built around GPs, rather than around the skills and competencies of modern health professionals. The Scope of Practice review is therefore an important first step for rural and remote people to build sustainable health care services by drawing on a wider pool of qualified and accredited health professionals. However, these reforms will require rural and remote communities to forcefully advocate for their local nurses, allied health and pharmacists to receive recognition for their advanced skills and qualifications, and to argue for an extension of Medicare rebates to these health professionals based on their competency and qualifications to provide treatment, rather than on their title.