Scope of Practice Review: Will reforms spark turf wars or transform the complex system?

An independent review commissioned by the Albanese Government, the Scope of Practice Review report, has revealed that nearly all health professions are hamstrung by restrictions and barriers unrelated to their skills, training, and experience. But can the health system stakeholders handle the sweeping reforms and will entrenched interests spark turf wars?

The Australian Medical Association (AMA) wasted no time in warning the federal government against reforms that could lead Australia down a path resembling the UK’s “primary care disaster.”

Federal Health Minister Mark Butler defended the review, calling it a wake-up call for change. “This review validates the frustrations of so many of our incredible health professionals: the health system does not enable and support them to consistently deliver the care that is within their skills, training, and experience,” he said.

Minister Butler emphasised the impact of such barriers on patients, saying “Removing these barriers would make it easier for Australians to get high quality health care, when and where they need it, without waiting weeks or driving long distances.”

The review pointed out glaring inconsistencies across states and territories, complicating patient access to care and hindering health professionals from working where they are needed most. Regional and remote areas bear the brunt of these inefficiencies, with red tape often preventing qualified practitioners from working to their full potential.

The government recently made strides by lifting outdated restrictions on nurse practitioners and endorsed midwives, removing the requirement for collaboration with a doctor. This move was hailed as long overdue, but the AMA remains cautious about broader reforms.

AMA President Dr Danielle McMullen noted the positives but highlighted concerns about an NHS-style model.

“We have always been very supportive of enhancing collaborative multidisciplinary care,” she said, “but this requires better funding models and improvements to the many reforms currently underway in general practice, such as MyMedicare.”

Dr McMullen also pushed for sustained investment in the GP workforce. “The federal government has acknowledged there is a GP workforce shortage, but it must resist implementing band-aid solutions that will only make the situation worse, as seen in the UK,” she warned.

Minister Butler argued that it makes little sense not to fully utilise the skills of all health professionals at a time when healthcare demand is skyrocketing.

The report also calls for uniform regulations across states, a proposal the AMA cautiously supports. However, Dr McMullen stressed that independent, profession-led bodies, not politicians, must oversee standards of training and clinical practice.

“Regulation of health professionals exists to protect the community and ensure the highest standards of care for patients,” she said. “This is not something that politicians should be meddling in.”

The Royal Australian College of General Practitioners (RACGP) echoed these concerns, urging the government to tread carefully. RACGP President Dr Nicole Higgins warned against direct referral pathways that bypass GPs, predicting a “two-tiered health system” where patients with the means will access care, while those without will be left behind.

“Direct referral to a specialist for something a GP can do won’t make our health system more efficient or cheaper for patients,” she argued, emphasising the crucial role GPs play in coordinating patient care.

Dr Higgins added that increased reliance on specialists could inflate healthcare costs and exacerbate workforce shortages in certain specialties.

“This isn’t gatekeeping,” she said. “It’s coordination of a patient’s care by a GP who knows them, their context, and their history.” Without that, she warned, patients could face fragmented care, duplicated efforts, and higher out-of-pocket expenses.

The review proposes the introduction of a new blended payment to enable access to multidisciplinary healthcare delivered by health professionals working to full scope of practice.

The new payment would be supported by a growth in investment in primary care, shifting the ratio of Australian Government payments for primary care from 90:10 fee-for-service: blended payments to 60:40 over time (at an aggregate national level). This recommendation addresses and supports the growth of new and innovative primary care models, the sustainability of which have historically been limited due to challenges accessing MBS funding. It recommends the introduction of a bundled payment for maternity care to enable consistency of funding for midwifery and shared care models.

It also recommends the implementation of new direct referral pathways for allied health professionals, midwives, nurse practitioners and remote area nurses to refer to non-GP medical specialists within their scope of practice, and with timely notification to GPs and relevant members of the multidisciplinary care team.

The year-long review led by Professor Mark Cormack, put forward 18 recommendations, addressing workforce design, regulatory reform, and funding policy. The extensive consultation process drew input from over 700 public attendees, 200 organisations, and nearly 1,200 written submissions, supported by the University of Queensland and an Expert Advisory Committee.

“Many of the recommendations will require cooperation between the Commonwealth and state and territory governments, as well as consultation with peak professional organizations, Ahpra, patient groups, and the sector more broadly,” Minister Butler explained.

The government will now weigh the findings alongside other ongoing healthcare and workforce reviews, with many eyes watching to see if Australia can truly seize this opportunity for meaningful reform.

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