Medicare

• That is, before the shift of education of nurses and other health professionals into universities in the 1980s.
• But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.
• But we now have a sensible pathway to improve access to care, using all health professionals appropriately.

A new vision for general practice

• To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home.
• The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work.
• The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.
• It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this.

How about pharmacists?

• Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.
• This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.

• Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.
• So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.

Who pays for all this?

• Clearly the government must increase its support for comprehensive general practice.
• This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear.
• In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities.
• Read more:
  Pharmacists should be able to work with GPs to prescribe medicines for long-term conditions

Stephen Duckett was a member of the Strengthening Medicare Taskforce and is a member of the Commonwealth Department of Health's Expert Advisory Panel for the Review of General Practice Incentives