Grace Quach MPS[/caption]
After months of anticipation, the Unleashing the potential of our health workforce – Scope of practice review was released yesterday (5 November) – with many of the key recommendations echoing the long-held concerns of the PSA and pharmacists across Australia.
Australian Pharmacist has rounded up some of the key takeouts from the report.
Pharmacists are leaving the profession at an alarming rate
Pharmacy has a high attrition rate compared with other healthcare professions. Among 19 healthcare professions, pharmacy had the fifth highest exit rate of 8.7% in 2023 – almost double that of medical professionals (4.7%).
The professions with the highest exit rates are those that face significant barriers to working to their full scope of practice, the review found.
While there are several factors that impact exit rates, allowing pharmacists to work to their full scope of practice is a crucial factor for strengthening the profession’s retention rate – improving recognition for professional skills, capability and contribution to enhance continuity of care.
‘This report really makes clear that there are all sorts of artificial, inefficient restrictions on what nurses, pharmacists, GPs, and other health professionals are allowed to do that bears no relationship to their training,’ said federal Minister for Health and Aged Care Mark Butler.
Inconsistencies in vaccine schedules for pharmacists are ‘needless’
Pharmacist vaccinators are trained in accordance with the National Immunisation Education Framework, ensuring high standards in vaccine administration and competence.
But the report found that the difference in state and territory laws dictating which vaccines can be administered by pharmacists has led to disparities in access – not only causing confusion among patients but leading to significant inefficiencies.
Legislative differences between states and territories also means that a vaccine subsidised in one region might not be covered in another.
Harmonising these regulations by reviewing Drugs and Poisons Acts would promote equitable vaccine access nationwide, allowing pharmacists’ to provide consistent healthcare services regardless of location.
Aligning funding arrangements for vaccination is also crucial, the review found. While the National Immunisation Program Vaccinations in Pharmacy (NIPVIP) provides government funding for certain vaccines, access to others depends on a mix of user-pay systems and varying jurisdictional funding – creating inconsistencies in affordability and accessibility across states and territories.
Standardising funding mechanisms would ensure subsidies are uniformly applied – making vaccinations more affordable and accessible to all Australians.
It will take some time to implement change, but there are some steps governments and regulators can take now
While some of the recommendations in the review, such as harmonising vaccination legislation, can be achieved in a timely fashion, others are sweeping reforms that will take many years, such as restructuring healthcare education – which currently impacts students and qualified pharmacists’ ability to work to their full scope.
The review recommended the Commonwealth establish a primary care workforce development program to support the development and retention of a skilled, stable, and collaborative primary care workforce through enhanced curriculum, training, placement, and career development opportunities for students, supervisors, mentors, and health professionals.
The current funding model must be overhauled
The current fee-for-service arrangement in primary care incentivises high-turnover care – with payments to providers based on the number and type of care episodes delivered.
This model limits the ability of health professionals to work to their full scope and reduces multidisciplinary collaboration – with some healthcare professionals funded for certain services while others are not, including lack of funding for pharmacists to participate in multidisciplinary case conferences.
To address this, the review recommends introducing a blended payment model to complement the fee-for-service system. This model would enable access to multidisciplinary healthcare delivered by professionals working to their full scope of practice in primary care.
An independent mechanism would be established to advise on pricing and payment levels for the blended payment, ensuring adjustments based on the risk profile of patient populations.
But it’s unlikely to be a quick fix. The review suggests the model would need to be implemented progressively over a 7-year period, beginning with priority areas such as rural and remote regions, Aboriginal Community Controlled Health Organisations, and underserviced regional and outer metropolitan areas.
Pharmacist prescribing programs should be nationally consistent
Implementing pharmacists prescribing rights has been an unnecessarily complex and prolonged process, with ad-hoc investigations, one-off reviews, and small-scale pilots.
Adopting an activity-based approach would streamline regulation for community pharmacists in prescribing medications and promote consistency across jurisdictions.
Introducing a dedicated mechanism to assess health workforce models would also fill a crucial gap, facilitating the systematic adoption of multidisciplinary primary care models that include pharmacists much like the successful models implemented in the United Kingdom.
Improved use of technology should form the backbone of scope of practice changes
A key theme in the review was the need for better use of technology across the board to expand scopes of practice and efficiencies, improving quality of care.
Potential areas for reform identified by the review include establishing access to real‑time patient information, introducing platforms for secure messaging and digital referrals and mandating participation in a multidisciplinary care team for primary care providers.
‘[We need to] improve the digital capability of a system that still uses far too many fax machines and too much paper,’ said Minister Butler.
The government will respond, in time
The government is yet to respond to the key recommendations in the report, with Minister Butler confirming he will not ‘respond to each of the ideas’.
‘We want to consider them, but a lot of them do have a lot of common sense,’ he said.
Other key stakeholders will also need to be consulted.
‘Many of the recommendations will require collaboration between the Commonwealth and state and territory governments, as well as consultation with peak professional organisations, AHPRA, patient groups, and the sector more broadly. I look forward to these discussions,’ Minister Butler added.
But PSA has called for the government to accept all 18 recommendations and put forward a plan of action now.
This review confirms PSA’s view that inconsistent regulations, unnecessary restrictions on practice, and siloed workforces are having a negative impact on patient access to quality health care, said PSA National President Associate Professor Fei Sim.
‘This report recognises the core role of pharmacies and pharmacists as primary healthcare providers and recommends a multidisciplinary approach to patient care,’ she said.
‘There is a clear alignment between Cormack’s recommendations and the actions in PSA’s vision for the pharmacy profession, Pharmacists in 2030. Both present a clear vision for the future that requires collaboration for a health system that works for patients.’
What the health sector is saying
The Australian Medical Association has said that the government ‘must resist’ changes to scope of practice, maintaining its position for even more investment into general practice.
Meanwhile, the Royal Australian College of GPs said the recommendations, if implemented, would ‘raid Medicare’, setting up for a ‘two-tiered health system where those who can afford to see a GP will, and those who can’t, don’t.’
But the Australian Nursing and Midwifery Federation said the review allows highly-trained health professionals to best utilise their skills, education and experience, allowing for the delivery of integrated, quality healthcare services across the community.
Support also came from the National Rural Health Alliance, who welcomed the recommendations that seek to address some of the ‘inequalities faced by rural Australians when it comes to accessing healthcare.’
Outside of the health sector, the Business Council of Australia also welcomed the report, citing improving ‘productivity, patient experience and workforce satisfaction’ as necessary to a sustainable health system.
