ACRRM provided its submission this week, responding to the phase one, Issues Paper, for the  Commonwealth Government’s Scope of Practice Review.

The Review focuses on health professionals who provide primary care and the associated evidence about benefits, risks, barriers and enablers to support them to work to their full scope of practice.

The Review has major implications for ACRRM members and for the rural, remote and First Nations communities they serve. At their best, more flexible scopes can enable the Rural Generalist approach with fit-for-purpose models of care that improve access to quality health care for these communities.

The College also recognises, the perverse consequences that badly constructed policies could present to already fragile rural and remote health services, and their potential to leave people in these areas with even less access to care.  

The College submission provides comprehensive feedback on both the risks and the opportunities.  This is the college’s second submission to the review. Our representatives will continue to progress these issues, through ongoing meetings and engagement with the review team.

Some key issues raised include:

• Policies must seek to provide people in rural and remote areas with the best possible care. This should at minimum, be at a standard comparable to that provided to their urban counterparts, albeit potentially through distinctive, rural generalist and other rural models of care. 
• The review analysis did not identify any potential risks or negative consequences arising from extended scope practice. It was recommended that the review pay more attention to these possibilities particularly the impacts for already underserved populations. A rural proofing lens should be applied to all recommendations.
• Policies should reflect responsibility for ensuring all Australians have reasonable access to a doctor. A key risk is that healthcare funders see opportunity for cost cutting by replacing provision of doctors with other health service providers. This could well lead over time to a broad acceptance over time that doctors are not needed outside citites. It would exacerbate the already unacceptable $6.5 million annual gap in the per capita health funding provided to urban and rural Australians.
• Another key risk is that broadening the scope of one profession may undermine the financial viability of other professions and trigger the loss of local services. Unlike in citites, the loss of a local doctor in a rural and remote town may render patients’ practical access to medical care very difficult or even prohibitive.
• Some positive initiatives for consideration, include, RG recognition, remuneration and inclusion in clinical framework reform, Single Employer Models, funding models to better value the services of rural practitioners,  including as supervisors, and innovative collaborative models in critically underserviced areas funding local doctors and healthcare teams supported by in-reach, outreach, and telehealth.
• The review should be informed by the Ngayubah Gadan Consensus Statement which provides guidance on appropriate approaches to extended scope care leveraging rural healthcare teams.

If you had any feedback or would like further information on these issues please contact the policy team at policy@acrrm.org.au