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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