Health workforce


Budget Review 2010-11 Index

Budget 2010–11: Health

Workforce

Dr Rhonda Jolly       

It is acknowledged that health system reform is unlikely to succeed without accompanying substantial workforce reform and pronouncements made by the Rudd Government have consistently implied it is supportive of such change. However, this Budget, like its predecessors, appears to deviate only marginally from conventional approaches to dealing with the dilemmas of a shrinking workforce and an opposing growth in demand for health workers. At the same time, it should be noted that while there is little real reform to be seen in the Budget, there remains the potential for some budget measures to be its precursors.

In recent months a number of workforce initiatives have been announced progressively, and the funding for these has been included as budget measures. Overwhelmingly, these measures focus on medical practitioners, with over $600 million allocated to increasing numbers over the next decade. Individual measures include doubling the number of general practice training places and expansion of the Prevocational General Practice Placement Training Program to enable more junior doctors to experience general practice.[1] 

Not surprisingly, increasing the numbers of doctors has been well received by the medical profession. The Royal Australian College of General Practitioners (RACGP) considers the Government’s investment in medical practitioners reaffirms the central role of general practice in the health system.[2] A supplementary measure to invest over $390 million to expand and restructure a general practice nurse initiative has also been generally well accepted.[3] The Australian General Practice Network believes the nursing initiative will alleviate workforce problems, and there is clear evidence that the initiative to date has indeed improved patient outcomes.[4]  

Questions can be raised, however, about whether this initiative will deliver where it is most needed. There appears, for example, to be no guarantee that solo practices, which could gain great benefits from the services of a practice nurse, will be eligible for funding under the measure. Similarly, it could be asked if it would be more appropriate to encourage nurses into aged care, rather than general practice. This is particularly so given the increases in medical practitioner numbers that will be realised, albeit not for a decade or so, as a result of government initiatives. Because this initiative focuses on supporting the traditional, medico-oriented perspective of health teams, it could be seen as a backwards step to realising a more cooperative and collaborative health workforce in the future.

Similar questions arise about how the investment in medical practitioner training, despite there being an emphasis on placements in rural areas, will benefit people in the bush.[5] There is no certainty this will be the case, as fully qualified Australian trained doctors cannot be forced to practice in a particular location.[6] It is therefore easy to understand the disappointment expressed by the Rural Doctors Association of Australia (RDAA) that there is not enough focus in this Budget on attracting doctors to rural areas.[7] The RDAA and the AMA insist that a rural rescue package is needed, but rural-specific measures are limited to an increase in an allied clinical placements scheme and the establishment of two locum programs for allied health workers and nurses.[8] These reflect assessment by the NHHRC that an integrated workforce package should apply across all health disciplines.[9]

The specific circumstances of rural Australia aside, it can be argued that the recent increase in medical training places, in conjunction with earlier complementary increases in university places for nursing and clinical training places for doctors, nurses and allied health professionals, is a significant step in the Government’s overall plan for the health system. Certainly, this is how it has been promoted in budget documents. The rationale in this argument is that increasing the numbers of health professionals in the community can provide the means by which health reform can look beyond care delivered in hospitals to a more cost effective and efficient community-centred delivery of services.[10]

However, it has been argued that such a strategy on its own is essentially flawed.[11] Increasing the number of health workers of any type, as a number of commentators have pointed out over time, will not resolve workforce problems, unless it is accompanied by complementary strategies.[12] Solving shortages and reforming the workforce to deal more effectively with disease prevention and management of persistent, long-term and recurrent conditions involves more tangential thinking around a variety of issues. These include: task allocation that provides for innovative and better uses of skill sets, not simply conventional use of skills; persuasive remuneration that draws practitioners to areas where their skills are most needed; and exploration of workforce related issues and patient involvement. These include, for example, consideration of how patient self-management can complement professional health service delivery and ways in which practitioners can be trained to work better with patients to improve health outcomes in such an environment. 

From this perspective, health commentator and academic John Dwyer is convinced that training dollars alone will not make general practice the preferred career choice for medical graduates, but complementary appropriate remuneration and job satisfaction may achieve this ‘desired effect’.[13] The Budget takes a small step in this direction by funding the two programs to provide locum placements for rural nurses and allied health workers noted above. The programs are clearly attempts to make rural practice more attractive. But these programs appear to be more ad hoc responses, rather than part of an integrated approach towards gaining a desired effect, or effects.       

Similarly, the provision of $18 million in seed funding to explore models of practice which may promote the use of nurse practitioners in the aged care sector has the potential to deliver significant workforce reform in the future. But its success may be dependent on the right combination of incentives and scope of practice leeway being in place to achieve the elusive desired effect.[14] The Australian Medical Association has already reacted negatively to the implication that nurse practitioners could have a role to play in aged care.[15] Given that the Government was forced to revise its only attempt at task reallocation—allowing nurses and midwives access to Medicare and the PBS—as a result of similar objections from the medical profession, it is likely to be wary of sparking a similar controversy. It would be easy to speculate that nothing will eventuate from this investigation because conventional numbers only and traditional task allocation strategies are less divisive and easier to ‘sell’ than contentious and potentially divisive reforms.

In essence, the Government’s enthusiasm for reform in other areas of the health portfolio is perhaps not matched in the workforce area. While previous budgets hinted there might be underlying enthusiasm to explore multiple options for workforce change, this Budget appears to have embraced a more traditional solution.


[1].    The Government has promised to deliver 1375 more general practitioners practising or in training by 2013 and 5500 new general practitioners or general practitioners in training in the next decade ($345 million). It has also provided for 975 places each year for junior doctors to experience a career in general practice during their postgraduate training period ($150 million) and 680 more specialist doctors in the next decade ($145 million). Australian Government Budget, A national health and hospitals network for Australia’s future: delivering better health and better hospitals, Commonwealth of Australia, Canberra, 2010, viewed 17May 2010, http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/report-redbook/$File/HRT_report3.pdf.   

[2].    Royal Australian College of General Practitioners (RACGP), Federal Budget recognises the central role of general practice, media release, 11 May 2010, viewed 13 May 2010, http://www.racgp.org.au/media2010/37442     

[3].    S Dunlevy, ‘Doctors and nurses’, Daily Telegraph, 10 May 2010, p. 1, viewed 12 May 2010, http://parlinfo.aph.gov.au/parlInfo/download/media/pressclp/43NW6/upload_binary/43nw61.pdf;fileType=application%2Fpdf#search=%22media/pressclp/43NW6%22

[4].    Australian General Practice Network, Budget delivers for Australia’s health care future, media release, 11 May 2010, viewed 13 May 2010, http://www.agpn.com.au/__data/assets/pdf_file/0004/24799/20100511_med_budgetreaction_final_short.pdf and see R Jolly, Practice nursing in Australia, Research paper, no. 10, 2007–08, Parliamentary Library, Canberra, 2007, http://www.aph.gov.au/library/pubs/rp/2007-08/08rp10.pdf.

[5].    W Snowden (Minister for Indigenous Health, Rural and Regional Health and Regional Services), Rudd Government continues to tackle the rural health challenge, media release, 11 May 2010, viewed 13 May 2010, http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-ws-ws043.htm?OpenDocument        

[6].    Civil conscription for medical practitioners is prohibited under section 51 of the Constitution.

[7].    Rural Doctors Association of Australia (RDAA), With a severe lack of rural workforce measures, this budget really needs a doctor, media release, 11 May 2010, viewed 12 May 2010, http://www.rdaa.com.au/uploaded_documents/Budget%20reaction%20--%20May%202010.pdf          

[8].    K Rudd (Prime Minister), N Roxon (Minister for Health and Ageing) and W Snowden, (Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery), Boost for allied health in rural and remote Australia, media release, 6 April 2010, viewed 12 May 2010, http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr10-nr-nr061.htm

[9].    National Health and Hospitals Reform Commission, A healthier future for all Australians: final report Commonwealth of Australia, Canberra, June 2009, viewed 17 May 2010, http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-report     

[10]. A Rosen, R Gurr and P Fanning, ‘The future of community-centred health services in Australia: lessons from the mental health sector’, Australian Health Review, vol. 34, no.1, May 2010,viewed 12 May 2010, http://www.publish.csiro.au/view/journals/dsp_journal_fulltext.cfm?nid=270&f=AH09741

[11]. For example, S Duckett, ‘Health workforce design for the 21st century’, Australian Health Review, vol. 29, no.2, May 2005, viewed 12 May 2010, http://parlinfo/parlInfo/download/library/jrnart/STHG6/upload_binary/sthg62.pdf;fileType=application%2Fpdf#search=%22Health%20workforce%20design%20for%20the%2021st%20century%22

[12]. Ibid.

[13]. J Dwyer, ‘Health plan needs a few dollars more’, The Australian Financial Review’, 11 May 2010, p. 63, viewed 12 May 2010, http://parlinfo/parlInfo/download/media/pressclp/LKNW6/upload_binary/lknw60.pdf;fileType%3Dapplication%2Fpdf      

[14]. Australian Government, Portfolio budget statements 2010–11: budget related paper no.1.11: Health and Ageing Portfolio, Commonwealth of Australia, Canberra, 2010, p. 377.

[15]. Australian Medical Association, Health Budget 2010–11: AMA welcomes substantial  investment in health and calls for careful implementation, media release, 11 May 2010, viewed 13 May, http://www.ama.com.au/node/5582     


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