Make the most of health workers’ skills and save money

by Stephen Duckett

Published by The AustralianTuesday 19 July

The boundaries of who does what in the health sector are essentially the same as they were 50 years ago. This ossification has occurred despite dramatic improvements in the educational preparation of nurses and allied health professionals (such as physiotherapists and occupational therapists) and equally dramatic changes in treatment techniques they use. Our health professionals now have much greater skills than they used to, but are not always allowed to practise their skills to the fullest.

Fifty years ago an apprenticeship model primarily prepared allied health professionals and nurses for practice. They learnt on the job with some formal class room preparation. Now both allied health professionals and nurses are educated in universities, some with a master’s degree as their initial professional qualification. Both have a solid scientific preparation and advanced skills in a number of areas that could be used to good effect to improve access to and efficiency of the health sector.

Improving rural and regional access

Despite significant growth in the number of graduating doctors, residents of rural and remote Australia still report difficulties getting to see a medical practitioner. When they do see a doctor, they pay higher out-of-pocket costs.

What is frustrating is that at the same time as some people can’t get to see a doctor, doctors are seeing patients for conditions that other professionals could manage. This conundrum must be addressed by better use of the skills of allied health professionals and nurses.

An obvious first step is to make better use of pharmacists’ skills. Pharmacists are highly trained, have deep expertise in medicines, and are located in communities throughout Australia. But their role is far more limited in Australia than in many other countries.

With the agreement of GPs and patients, pharmacists should be able to provide repeat prescriptions to people with simple, stable conditions. They should also be able to provide vaccinations and to work with GPs to help patients manage chronic conditions.

We also need to increase access to other services, including diagnosis, which only GPs can provide at present. Australia should introduce the category of physician assistants: health workers who practise medicine under the supervision of a doctor. There is good evidence that physician assistants could expand the care available in under-served areas, without compromising quality or safety.

Reallocating roles 

Too many hospital-based health professionals squander their valuable skills on work that other people could do. In most cases, it doesn’t take 15 years of post-school training to provide light sedation for a stable patient having a simple procedure. Nor does it take a three-year degree to help someone bathe or eat.

But tradition, professional culture and industrial agreements often dictate that highly trained health professionals spend their time doing straightforward work. This wastes money, makes professional jobs less rewarding and often does not improve care.

There are many ways that hospitals can get a better match between workers and their work. They could use more nursing assistants to provide basic care to patients. They could let specialist nurses do common, low-risk procedures currently done by doctors. They could use nurse practitioners to provide specialist care in outpatient clinics, and employ more assistants to support physiotherapists and occupational therapists.

These changes, which can maintain or improve the safety and quality of care, are among the easiest to take up. Hospitals don’t have to be reorganised or new professions created. They would save public hospitals at least $400 million a year, funding treatment for more than 85,000 extra people.

Why isn’t change occurring?

Role change could improve access for patients, save money and make the jobs of health professionals more interesting. Despite these benefits, progress is slow. Regulations, culture, tradition and vested interests stand in the way.

Three things are needed to facilitate role change. First, hospitals, regulators and professional bodies must modernise regulations. Second, the commonwealth must change funding arrangements to help implement new roles for professionals in primary care. Third, state governments must invest money and expertise in spreading good practices.

Current workforce roles were designed in the days of the horse and buggy. The choice to update them should be easy.