Workforce
Dr Rhonda Jolly
Health workforce initiatives in the Government’s first
budget reflected that it had had little time to develop a
comprehensive strategy to begin to address structural problems
relating to the supply and distribution of health workers in
Australia. Nevertheless, the 2008–09 Budget increased the
number of training places for health professionals and further
funding increases for training have been delivered since that
time.[1]
According to the 2009–10 Budget papers, the Government has
developed an agenda for reform which will make the health system
‘more responsive, coherent and efficient’ by using the
skills of all health workers better.[2] Despite this claim, while there are
some workforce innovations in the Budget, it appears that many of
the measures announced are about rearranging or continuing with
current programs, sometimes in different guises.
The major workforce measure, the Rural Health Strategy for
example, mostly involves either consolidation or reorganisation.
The Registrars Rural Incentive Payments Scheme (RRIPS) and the
Rural Retention Program (RRP) for general practitioners are to be
consolidated into a General Practice Rural Incentives Program. The
Budget papers claim this new program will provide incentives for
relocation and retention—but these are already available
under the existing schemes.[3] Almost $100 million has already been spent on the RRP in
the last five years. The $64.3 million planned for the next four
years is a continuation of this funding. Similarly, other
measures in this package, such as the commitment to increase locum
relief to doctors in rural and remote areas, are not substantially
different to existing arrangements.
The other significant workforce initiative in the Budget extends
access to the Medicare Benefits Schedule and Schedule of
Pharmaceutical Benefits for nurse practitioners and midwives. From
one perspective, it can be argued that this measure will be of
great benefit to rural and remote communities, which often cannot
access the services of medical practitioners. From this
perspective, the measure not only reflects the reality that nurses
and midwives are integral to the birthing experience; it is also an
innovative use of alternative medical practitioners. It could be
seen as indeed a first step in a structural reform of the health
workforce, and as such, it could be argued that it is the most
far-sighted health workforce measure in this Budget; one which one
of the health professions considers a landmark reform.[4]
On the other hand, this measure raises a number of questions
about what will be defined as the appropriate range of services for
which Medicare benefits will be paid to nurse practitioners.
Questions can also be asked about what will constitute subsidised
medical indemnity for eligible midwives, how will eligibility
be defined, what will the advanced midwifery credentialing
framework noted in the Portfolio Budget Statements entail, and how
will it differ from existing assessments.[5]
The nursing measure has been criticised in some quarters. For
example, the Royal Australian College of General Practitioners
(RACGP) has argued that, unlike funding for practice nurses, the
$59.7 million provided to support the expansion of the role of
specialist nurse practitioners ‘does not meet the workforce
needs of Australian general practice’.[6] This criticism is most likely based on
the fact these practitioners work in independent practice and not
as part of a team supervised by medical practitioners. This
view illustrates one obstacle to any substantial health workforce
reform. That is, that each of the health professions is protective
of its traditional boundaries and reluctant to concede that
alternative approaches may deliver more efficient and effective
health outcomes.
There is little attention paid to the allied health workforce in
this Budget. Announcements specifically related to the allied
health workforce are targeted at rural areas. Dental students will
receive $4.1 million over four years for clinical training in rural
areas and $6.8 million will be provided under the University
Departments of Rural Health program to encourage students in other
health professions (including medicine) to practise in rural areas.
Incentives offered to allied health workers (and to nurses) to work
in rural and remote settings, however, are significantly less in
comparison with those offered to medical
practitioners.
The Budget allocates funding to the training of Indigenous
health workers. This includes funding for 160 new Indigenous
Outreach Workers and 75 allied health workers and practice managers
to work in Indigenous health services and for the development of a
National Indigenous Health Workforce Training Plan. In addition,
the Government will continue to support the Puggy Hunter Memorial
Scholarship Scheme to encourage more Aboriginal and Torres Strait
Islander people to enter health professions.
A long-awaited and needed review of the Rural Remote and
Metropolitan Area (RRMA) classification scheme, upon which
qualification for a number of health programs has been based, took
place before the Budget. This review appears to have influenced the
Government to commit to moving qualification requirements to
reflect the Australian Standard Geographical Classification, which
is based on 2006 Census data. The Budget papers indicate that this
move will deliver a bonus for medical practitioners, as 2400 more
doctors will be eligible for rebates under the scheme. However, it
remains unclear what advantages this change in program
administrative arrangements will have for workforce outcomes. In
addition, there is no guarantee that that there will not be losers,
in terms of rebates or qualification requirements.
Overall, this Budget does not provide a comprehensive health
workforce reform package. However, it could be argued that the
first steps towards such a package have been put in place and are
currently being taken by bodies such as the National Health and
Hospitals Reform Commission. This process will be advanced
further by new agencies to be established as a result of the
Council of Australian Government’s various national
partnership agreements—the outcomes of the process may
deliver more comprehensive health workforce funding announcements
in subsequent Budgets. [7]
[1].
J Gillard (Deputy Prime Minister) and N Roxon (Minister for Health
and Ageing), COAG to deliver up to 50 000 more frontline health
workers, media release, 28 March 2008, viewed 13 May
2009,
http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-nr-nr036.htm
and Council of Australian Governments meeting 29 November 2008,
attachments to Communiqué, Attachment A,
viewed 13 May 2009,
http://www.coag.gov.au/coag_meeting_outcomes/2008-11-29/attachments.cfm#attachmenta
[2].
Australian Government, Portfolio budget statements
2009–10: budget related paper no. 1.10: Health and
Ageing Portfolio, Commonwealth of Australia, Canberra, 2008,
p. 301.
[3].
Department of Health and Ageing, ‘Rural Retention
Program’, viewed 13 May 2009,
http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pr-rrp
and Department of Health and Ageing, ‘Registrars Rural
Incentive Payment Scheme’, viewed 13 May 2009,
http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pr-rrips
Note: the Registrars scheme only provides incentives for
undertaking training in rural areas.
[4].
Australian Nursing Federation, Patients and the community are
the big winners in ground breaking health reform budget, media
release, 12 May 2009, viewed 14 May 2009, http://www.anf.org.au/
[5].
The Australian Nursing and Midwifery Council currently works in
conjunction with state and territory nursing and midwifery
regulatory authorities to produce national standards which are an
integral component of the regulatory framework to assist nurses and
midwives to deliver safe and competent care. Standards include
national competency standards for registered nurses, enrolled
nurses, midwives and nurse practitioners and codes of professional
conduct and ethics. These are available on the Council website,
viewed 14 May 2009, http://www.anmc.org.au/professional_standards/index.php
[6].
Royal Australian College of General Practitioners, Budget lacks
recognition of the role of primary care, media release, 12 May
2009, viewed 14 May 2009, http://www.racgp.org.au/media2009/31787
[7].
Council of Australian Governments, National Partnership
Agreement on Health and Hospital Reform, December 2009, viewed
14 May 2009,
http://www.coag.gov.au/intergov_agreements/federal_financial_relations/docs/
national_partnership/national_partnership_on_hospital_and_health_workforce_reform.rtf
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