Scope of Practice Review: patient safety a concern

Avant Mutual has raised its voice in the ongoing Scope of Practice Review, emphasising the need for prioritising safe, collaborative, and patient-centred primary care.

The independent review, which is exclusively focussed on primary care, is identifying opportunities to remove barriers hindering general practitioners (GPs) and other health professionals from working to their full scope of practice, particularly in multidisciplinary teams. Multidisciplinary teams were recommended by the Strengthening Medicare Taskforce and are viewed by the government as a strategy to improve the accessibility of healthcare services.

The review unveiled its second issues paper in April outlining a set of reform options. Notably, the review acknowledged the necessity for all health practitioners to maintain their own insurance coverage – a position Avant has long advocated for and that reassures patients and practitioners alike that any professional indemnity issues can be adequately addressed should they arise.

However, Avant has also identified several concerns regarding patient safety and quality of care which will be the focus of our forthcoming feedback. These concerns include:

• An emphasis on practitioner-focused tasks and activities rather than patient relevant outcomes and collaborative care.
• Safety implications of proposed changes to education, including suggestions of minimal supervision for healthcare graduates working in primary care.
• Risk of care fragmentation and reduced patient safety due to additional referral pathways without automated sharing of e-health records.
• Lack of clarity in funding proposals regarding the oversight role of GPs in multidisciplinary teams, potentially affecting continuity of care and viability of existing practices.
• Insufficient clarity and detail in some proposals, such as a proposed national skills and capability framework and matrix.

Avant Chief Medical Officer, Dr Michael Wright, highlighted the importance of acknowledging the potential risks associated with some of the proposed options.

“Primary healthcare should not be reduced to a series of mere tasks and processes but needs to consider the complexities of holistic patient care,” he said.

“Patients are individuals with unique needs and circumstances, not just collections of symptoms.”

In our previous submissions to the review, Avant advocated for GP-led multidisciplinary team-based care as an effective pathway to benefit patients and to enable health professionals to work together to their full scopes of practice. 

These collaborative care models ensure that patients receive safe and appropriate care tailored to their needs. GPs play a crucial role as facilitators and advocates for their patients, providing leadership, clinical oversight and continuity of care. 

Such an approach recognises that not all clinical presentations are created equal. While many presentations appear straightforward on the surface, this can mask underlying complexities, drug and disease interactions, and social factors which require the diagnostic and treatment acumen of a GP.  

“What may seem like a routine case of a sore throat or a minor injury could be indicative of a more complex or chronic condition which is best diagnosed by a GP,” Dr Wright said.

Avant continues to be deeply involved in ongoing discussions with the review, aiming to mitigate any negative effects on GPs. As the review progresses to its next phase, Avant plans to submit detailed submissions, engage directly with the lead reviewer, Professor Mark Cormack, and conduct advocacy efforts with policymakers.

Dr Wright stressed the value of all health professionals and the importance of fully using the skills and experience of all primary care health practitioners in a safe and considered manner. 

“As more practitioners take on broader scopes of practice, there is an increased risk of primary care fragmentation and an increased potential for misdiagnosis, inappropriate treatments and errors in care,” he said. 

“These are complex issues that warrant careful consideration to ensure patient safety remains paramount. We will continue to advocate for a model that uses the strengths of all primary healthcare practitioners within a collaborative team led by the expertise of a GP.”