Scope of Practice Review offers hope for rural health workforce

An important review has commenced, which has the potential to impact health delivery in rural and remote Australia. Unleashing the Potential of our Health Workforce—Scope of Practice Review is an independent review that will examine the barriers and incentives health practitioners face working to their full scope of practice in primary care. Professor Mark Cormack from the Australian National University (ANU) College of Health and Medicine will lead the Independent Scope of Practice Review. The impetus for this review comes from the Strengthening Medicare Taskforce Report, which recommended governments work together to review the barriers and incentives for primary health care professionals working to their full scope of practice. It is important to note that the review focuses on health practitioners working to their current full scope of practice and is not examining recommendations on changes or extension/expansion of scopes of practice. Research suggests that regulating health professional scope of practice requires a balance between enabling flexibility and ensuring accountability.1 While regulation is only one of several key factors involved in influencing scope of health practitioner practice,2 this is an important concept to have front of mind when considering the potential benefits, risks and enablers of scope of practice. Flexibility allows health care teams to determine roles and responsibilities in alignment with population need, while accountability is essentially about protecting patient safety and ensuring practitioners work in line with the law and recognised standards of practice.1 In their assessment of regulatory approaches to health professional scope of practice across the USA, Canada, the UK and Australia, the aforementioned researchers proposed that appropriate management resulted in both the efficient and effective deployment of health workforce; enabled innovation, allowing the workforce to be responsive to local needs; and facilitated collaboration amongst health professionals within teams. The Alliance wishes to highlight the importance of considering both dimensions of scope, including breadth and depth or level of practice.5 Prioritising narrow over wide breadth of scope risks not meeting the needs of rural and remote populations, given their geographic isolation, lack of health workforce and reduced access to services. Rural generalist (RG) medical practitioners are essential to the provision of health care in rural and remote areas. They may work across both primary and secondary care and have advanced skills in a specific area in addition to general practice, such as obstetrics, emergency and anaesthetics. They can manage the broad range of conditions that people present with across the lifespan. The need to prioritise generalism (wide breadth of scope) in the medical workforce is highlighted in the National Medical Workforce Strategy.6 A focus on wide breadth of scope is inherent in the development and implementation of the Allied Health Rural Generalist Pathway (AHRGP)7 and the National Rural and Remote Nursing Generalist Framework.8 Both of these mechanisms aim to facilitate the development of a rural and remote workforce with the breadth of scope relevant for the context. The potential risk of reduced coordination and integration of care when health professionals are working to the top (full depth) of their scope of practice should also be considered. It has been proposed that this might occur where professionals are working in silos rather than collaboratively within a team. This is both a system-level consideration and one for individual professional educational providers and regulatory bodies. The provision of safe, high-quality care is essential, and rural, regional and remote communities are just as entitled to expect this as people living in major cities. As an outcome of this review, we would like to see a balance found that enables improved recruitment and retention of the rural, regional and remote health workforce and improved efficiency in the performance of that workforce, while maintaining high standards of patient care. This review is going to be undertaken over at least the next year, and the Alliance will be contributing input through various mechanisms. Clare Fitzmaurice: Conceptualization; investigation; writing – review and editing. Margaret Deerain: Writing – original draft.

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