The Department of Health and Aged Care has embarked on a sweeping scope of practice review across the primary healthcare sector, called Unleashing the Potential of our Health Workforce. This holds implications for podiatrists across Australia as it seeks to delineate the boundaries within which healthcare providers operate.
The review looks at the available evidence around the ability of health professionals to deliver on their full scope of practice in primary care.
In the words of the official statement, the review is, “identifying opportunities to remove the barriers stopping health professionals working to their full scope of practice. It is also drawing on examples of multi-disciplinary teams where members are working to their full scope of practice to deliver best practice primary care.”
With regards to podiatry, this includes nuanced considerations. Podiatry is uniquely positioned in the scope of practice review. It is one of the few allied health professions that has prescribing rights, minor surgical procedures and vascular assessment within the current scope. With much discussion around workforce retention, the ability to provide input into this highly relevant and important review is critical.
While the Australian Podiatry Association (APodA) cannot define the scope of practice, given this is a regulatory issue above all else, it has developed a decision-making framework for its members.
This decision tree was designed in response to members asking questions around whether they are covered by insurance for particular interventions and what kinds of assessment, diagnostic and treatment modalities are within the scope of common practice. It self-guides podiatrists through relevant considerations, to make independent decisions with more clarity.
The Strengthening Medicare Taskforce Report highlighted the need for more collaborative cross-government efforts. In particular, to address obstacles that prevent healthcare professionals from being able to deliver comprehensive services. In response to this, the National Cabinet endorsed the Taskforce’s recommendations and the Commonwealth Government funded the review.
According to the official government statement, “Unleashing the Potential of our Health Workforce is an independent review, led by Professor Mark Cormack. It is looking at the available evidence about health professionals’ ability to deliver on their full scope of practice in primary care.”
The APodA has attended multiple Commonwealth briefing sessions online and in person, and is actively seeking input from the profession, as described further below (Question 8). A submission is underway to highlight podiatry’s unique offering within any primary health care team. This submission also addresses key barriers around direct referrals, which can stand in the way of optimal care. It also raises current limitations that relate to prescribing rights.
Without this review, the patient journey may be impeded; given healthcare providers risk being unclear as to one another’s scope of practice, or sometimes in active disagreement. This can create inefficiencies for the patient, lead to potentially worse health outcomes, increase patient costs, increase systemic healthcare costs, and compromise the resources of an already finite and arguably diminishing health workforce.
The following example provides a little more context as to why a clear scope of practice is essential across all primary healthcare sectors.
A patient has Achilles tendonitis and a foot wound, which risks becoming infected. They can’t run which they normally enjoy doing. They go to their doctor who refers the patient to a physio. The physio assesses the wound and realises the biomechanics of the foot require podiatric intervention, so they suggest the patient sees a podiatrist.
By now, around three weeks have passed between booking the doctor’s appointment, booking the physio appointment, and the patient attending and paying for both appointments. Now the patient is required to book a podiatry appointment, and the patient’s foot is still in pain. Physical exercise has become unbearable, not only limiting the patient’s ability to move freely but also to attend work.
The patient sees a podiatrist who requires pathology tests and scans; some calcaneum has come off with this Achilles tendonitis and a CT or MRI is required. The podiatrist does a biomechanic assessment and sends the patient back to the GP for these pathology referrals. The GP then orders some blood tests in addition to writing out the pathology referrals. The patient waits for their blood tests and pathology appointments, and waits again for the results.
By this point, many weeks or even months have passed for the patient. By now, the patient has seen multiple primary healthcare providers at great personal expense in every sense. Let alone layering this picture with inconsistent digital health records, which further undermines the patient journey.
This patient outcome could be avoided through more clarity across the primary healthcare sector as to each provider’s scope of practice, as well as accompanying education for all involved.
The review aims to reflect on the above types of patient challenges outlined in the case study. The goal being, to make this entire journey more person-centric and result in better patient outcomes, as well as being less costly and frustrating to the patient – and the system.
The review is not – nor should not – be about one healthcare provider having ‘more’ or ‘less’ than another healthcare provider.
With the above in mind, differing thoughts exist around whether it is more beneficial to work at the top of scope or simply within scope; with current policy levers and funding decisions arguably encouraging the latter. For a robust perspective on this issue, members should read the updated Workforce Report, available via the APodA website.
Then there is organisational distribution to consider alongside associated barriers to the scope of practice, which are all covered in this review’s latest issues paper.
Working to the top of scope and being able to create more efficiencies within the healthcare system arguably helps to retain more podiatrists, which theoretically supports the sustainability of a diminishing workforce. There is certainly a case for everyone to work to the top of their scope for the sake of the patient, the future of the podiatry workforce, and the resilience of the broader health system. However, the mainstay of any scope concurrently remains critical, given ‘everyday’ consultations can account for the majority of a patient’s healthcare needs and help to support preventative healthcare measures.
Ultimately such reflections risk being academic rather than practically-relevant, given global allied healthcare shortages create a pressing demand for healthcare services that far outweighs the supply of skilled healthcare professionals. This tension can erode the ability of an individual healthcare provider to have the ability to choose whether to work to the top of their scope or within its mainstay, or a combination of both.
Variables further abound, highlighting a need for this review to deliver a nuanced approach. One such example is regional, rural or remote podiatrists who are often required to be more of a ‘generalist’, which requires a uniquely skilled approach within itself. Likewise, many podiatrists work more often in aged care, paediatrics, sports, and so forth; with each area of special interest needing to be factored into this picture.
There are several ways to get involved in this review and some surrounding initiatives:
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