The release of the Strengthening Medicare Taskforce Report —the culmination of a more-than-two-year review of MBS and primary care in Australia—heralds an exciting phase for the allied health space. However, its publication has precipitated numerous reservations and concerns from allied health peak bodies and stakeholders.
Allied health have a critical role to play across the continuum of care, but particularly in primary health care. Allied health is clearly well positioned to meet the primary health care needs of the communities we serve. However, to be most effective, primary health care requires an integrated approach. A multidisciplinary approach to health care can ensure that it is delivered in a way that is centred on people’s needs and respects their preferences.
The Taskforce and subsequent report have been contentious—there have been concerns around the potential impact of changes to the MBS on access to primary care networks, that the review process was opaque and lacked impartiality, that the review was overly focused on cost-cutting, and that the reimbursement for some allied health services will be negatively affected as a result of the review.
The most common concern among allied health peak bodies is that they won’t be consulted during the planning or the implementation of actions intended to make PHNs more accessible and equitable, in multidisciplinary care environments that can truly work.
Responses to the report’s key recommendations by various allied health peak bodies
The recommendations can be grouped into four areas: improved funding models and access; encouraging multidisciplinary team-based care; updating digital infrastructure and innovation; and cultural change through community dialogue.
Increasing access to primary care : Prima fasciae this has been universally endorsed and welcomed, but with some caveats. A sustainable model for primary care is not just about more money for general practice. AHPA and other allied health peak bodies have voiced concerns that greater PHN investment would merely be a mechanism to “supplement general practice teams” . It has been pointed out that the inadequacy of Medicare rebates in allied health practice was not addressed in the report, and that the Taskforce needs to consider support models being put forward by the allied health sector.
Encourage multidisciplinary team-based care: As a sentiment and basic statement of intent, this has been met with approval and endorsement, underlined by concerns around lack of consultation. AHPA states that such a recommendation must be followed by an implementation roadmap and open dialogue with the allied health sector. Endorsements of this recommendation come with the expectation that current issues such as referral pathways, and existing impediments to effective multidisciplinary care environments, will be addressed. Other peak bodies see the taskforce report as an opportunity to formalise multidisciplinary initiatives that they have been working on for some time, such as increased prescribing rights for hospital pharmacists.
One recommended strategy for increasing primary care access in general, and multidisciplinary team-based care in particular, involves boosted funding for the Workforce Incentive Program (WIP); the WIP provides funding to general practices to engage nursing or allied health professionals, including Aboriginal and Torres Strait Islander health workers in their practice. While colocation of practitioners can enhance multidisciplinary team work and engagement, AHPA is opposed to this model, and many in the allied health sector have opposed WIP since its inception. According to AHPA CEO Bronwyn Morris-Donovan : “There is no evidence that the employment of allied health professionals under the WIP has improved access to multidisciplinary care.”
Modernising primary care : Improved access and more effective multidisciplinary primary care requires updated digital infrastructure and resources. Sub-optimal digital infrastructure has resulted in communication gaps between clinicians, consumers and primary care AHPs using different systems . However, updates to the My Health Record to effect a real-time, fully-integrated digital health system has elicited concerns that “digital recommendations offer no reassurance that allied health will be prioritised.” Potentially, this is an opportunity for allied health stakeholders to make themselves heard, and influence the development and rollout of digital resources and infrastructure.
Supporting change management and cultural change: This recommendation places consumers and communities at the centre of primary care policy design and delivery, as well as working with providers to help them effectively manage future changes. This is an opportunity for the allied health sector to positively and vocally influence initiatives around change management and cultural change.
The Primary Health Networks, in consultation with allied health peak bodies, have established The National PHN Allied Health in Primary Care Engagement Framework, which is designed to enhance collaboration between allied health professionals and their primary health networks. If successful, implementation of the Framework could support better integration with allied health professions at a regional level and address some of the concerns raised in the Taskforce feedback.
In this edition of Allied Health Insights
- To demonstrate the enormous value of allied health across the continuum of care, our article this week looks at 10 ways that allied health can keep people out of hospital, from prevention and admission avoidance to ‘prehabilitation’ and ensuring a safe and timely discharge home.
- Taking this to a specific clinical example, we spoke with certified practicing speech pathologist Ricci Presser. Ricci was one of the pioneers of telehealth in speech pathology, helping people to maintain their independence by receiving services at home.
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Allied Health Insights is a newsletter published by AHP Workforce, a wholly owned subsidiary of HealthWork International, offering thought-provoking and incisive commentary on issues that affect the allied health professional space.