Guide to Allied Health Professions in the Primary Care Setting

Transcription

1 Guide to Allied Health Professions in the Primary Care Setting

2 Publication: Guide to Allied Health in the Primary Care Setting Date: July 2013 ISBN: Australian Medicare Local Alliance Australian Medicare Local Alliance (AML Alliance) is a national, government funded not-for-profit company which spearheads the development of the primary health care system across the country through a network of 61 primary health care organizations called Medicare Locals (MLs). Together with Local Hospital Networks, MLs form a critical part of health care governance arrangements at a local level. This guide has been developed to support MLs when engaging with Allied Health Professions. Further information on the role of AML Alliance or MLs can be found at: Website: Telephone: Fax: reception@amlalliance.com.au Address: Australian Medicare Local Alliance Ground Floor Minter Ellison Building 25 National Circuit Forrest ACT 2603 Postal Address PO Box 4308 Manuka ACT 2603 i

3 Foreword Over 90,000 Allied Health professionals work in Australia representing 20% of the country s health workforce. As the third pillar of health care they are responsible for working with patients to alleviate the effects of illness or disability and to promote health and wellbeing within the population. They work in all care types, including primary, acute and chronic care; and in all health care settings including GP clinics, aged care residences, schools and leisure centres. Their work is characterised by vast variation in their degree of autonomy, dependence on technology, regulation and required training. With no consensus on what the term Allied Health encompasses, key decision makers such as Medicare Locals (MLs) are often unaware of the impact of their decisions on Allied Health, or the role of Allied Health in healthcare planning. This is set to be addressed to some degree with the appointment of the Government s first Commonwealth Chief Allied Health Officer in Currently MLs are working towards providing high quality primary health and social care for our local community through tackling existing inequalities and introducing new opportunities to bring together all health care professions (GPs, Nurses, Allied Health etc). MLs have a responsibility to monitor the health workforce in their area and to align this to the population s needs. A major challenge for MLs is how to fully understand the diversity in roles and services of the Allied Health professions. Collaboration with Peak bodies has been established as a critical factor to gain a deeper understanding of each profession. Allied health professions for a long time have been delivering a range of specialist s services within the primary care setting. It is hoped this guide will raise the awareness of the professions including recommendations of how to engage, collaborate, support and strengthen partnerships for the benefit of all patients. This Guide has been produced on behalf of the Australian Medicare Local Alliance (AML Alliance) following consultations with both MLs on their information and support needs and Allied Health Peak bodies regarding the role of their respective professions. For further enquires please contact: AML Alliance Emma Whitehead ii

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5 Acknowledgements Australian Medicare Local Alliance gratefully acknowledges the financial and other support from the Australian Government Department of Health and Ageing. We would like to acknowledge and thank all contributors from the Allied Health Professions in Australia for their support in providing information for the development of this guide. Peak bodies include: Audiological Society of Australia: Audiology Australia (ASA) The National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA) The Chiropractors Association of Australia (CAA) Dietitians Association of Australia (DAA) Australian Diabetes Educators Association (ADEA) Exercise and Sports Science Australia (ESSA) Australian Music Therapy Association (AMTA) Occupational Therapy Australia (OTA) Optometrists Association Australia (OAA) Australian Orthotic Prosthetic Association (AOPA) Orthoptics Australia (OA) The Australian Osteopathy Association (AOA) Australian Physiotherapy Association (APA) Australasian Podiatry Council (APodC) The Australian Psychological Society (APS) Australian Association of Social Workers (AASW) Speech Pathology Australia (SPA). In addition we would like to also thank other organisations that contributed to the development of the guide including: Indigenous Allied Health Australia (IAHA) Services for Australian Rural and Remote Allied Health (SARRAH) Allied Health Professions Australia (AHPA). iv

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7 Table of Contents 1. Introduction 8 2. Allied Health in Primary Care Allied Health, Requirements and Regulations Allied Health Professions Allied Health Peak Bodies Working Collaboratively to Achieve Integrated Care Resources 57 vi

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9 1 Introduction 8

10 Introduction As strategic Primary Health Care Organisations, MLs are tasked with orchestrating a local system of care spanning health promotion, prevention and primary care: bringing together service providers across the local health economy to achieve greater collaboration and integration for the benefit of patients and the health system alike. Allied Health clearly has an important contribution to make to the health and wellbeing of the local community and is a core component of integrated care at a primary care level. Increasing emphasis is being placed upon the role of Allied Health through for example, the appointment of the Government s first Commonwealth Chief Allied Health Officer (2013). The Chief Allied Health Officer s role is to raise the profile and strengthen the role of Allied Health and provide advice on how best to strengthen primary care provision. It is essential that the unique depth and breadth of skills, knowledge and roles of Allied Health professions are understood, valued and appropriately utilised within the development and delivery of primary care. This guide is developed by the AML Alliance to support MLs achieve their strategic objectives and is aimed at improving the understanding of the roles and services Allied Health currently offer. Information detailed herein has been gathered from Allied Health Peak bodies and organisations who are keen to establish joint working relationships with MLs at national, jurisdictional and regional levels (as appropriate). The guide specifically encourages MLs to look beyond General Practice to foster greater understanding of, collaboration and integration with Allied Health services. Making a Difference A real difference to the quality of life and wellbeing of the local population can be achieved through working collaboratively with all relevant professions and organisations within primary care. The Allied Health professions look forward to working with MLs as equal partners to provide quality healthcare to all Australians. AHPA Dietitians Association of Australia (DAA) and MLs DAA has set up a Medicare Local Discussion Group which communicates by through a collected list including a new DAA Health Informatics Advisory Committee for e-health. Medicare Local events are posted on the DAA calendar of public events and circulated to the Medicare Local Discussion Group. Information, and opportunities to participate in Medicare Local activities, can be shared with dietitians through DAA networks. Allied Health Profiles MLs should not underestimate the importance of having an accurate profile of Allied Health professionals so GPs can promote timely and appropriate access to services and supports for patients. Audiology Australia 9

11 Purpose of the Guide This guide provides information for MLs who are looking to increase their knowledge and understanding of the significant role and contribution of Allied Health professions. It aims to: Educate and raise awareness of Allied Health professions, their regulatory frameworks and associated peak bodies Encourage greater involvement of Allied Health professions Highlight examples of how Allied Health professions contribute to better health within the primary care setting This guide provides the following information: Chapter 2 illustrates the role of Allied Health in primary care and their contribution to Chronic Disease Management Chapter 3 sets out the role of Allied Health and the associated Regulatory Framework Chapter 4 demonstrates the role and contribution of Allied Health professions including an outline of the services provided, professional credentials, top tips for engaging with the profession and links to further information Chapter 5 clarifies the role of associated peak bodies and summarises the services offered to members Chapter 6 suggests how MLs could achieve greater collaboration based upon feedback from Allied Health peak bodies Chapter 7 provides additional information for reference purposes. Ultimately the purpose of this guide is to promote greater collaboration across primary health care professions to assist patients achieve optimum health and wellbeing. The guide augments the work of the AHPA, peak bodies and organisations that are critically important in supporting Allied Health professions. Why is it important Medicare Locals engage with Allied Health? Service Coordination A well coordinated health service provides a comprehensive and continuous experience for the patient More effective and cost efficient service provision Patient-centred care Better long-term outcomes for the patient Increased focus on prevention, self -care and independence Reduced reliance on inpatient care Facilitate earlier discharge from hospital and prevent re admission More creative usage of services to deliver efficient and accessible service Provision of alterative treatment options Wider and more flexible treatment choice for the patient Improved used of existing skills with the primary care setting Improved understanding of Allied Health roles and expertise Promote early referrals and timely interventions Better case management and communication between professions 10

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13 2 Allied Health in Primary Care 12

14 Allied Health in the Primary Care Setting There is robust evidence supporting the contribution that Allied Health makes to local community health as partners in the delivery of a patient-centred, seamless system of care. Allied Health professions have a longstanding and significant role within the primary care setting. In primary care, Allied Health professions can work individually or as part of a multi-disciplinary team alongside GPs, nurses, social care staff and others to provide access and effective care for patients. Referrals to these services come from a variety of settings including clinics, schools, other Allied Health professionals, GPs and residential care. Allied Health professions contribute across the full scope of primary care activities from needs assessment, health promotion and community development, through to direct provision of specialist treatment and rehabilitation services. These professions help people manage their physical and/or mental health condition, overcome barriers related to disability and live as independently as possible. In addition to their general role in promoting health and the prevention of associated problems, each Allied Health profession has an educational role in promoting self-care. This involves advising and supporting individuals and their families to gain the maximum benefit from the services provided. Aboriginal Health Partnership in Primary Care By liaising with local GPs and other health services Aboriginal and/or Torres Strait Islander Health Workers (AIHWA) run various programs aimed at supporting and advising patients who require assistance with a variety of health promotion topics including: smoking cessation advice, drug and alcohol issues and other support like healthy eating. The AIHWA s patients may also be directed to other programs or initiatives when needed. For example, the Aboriginal Maternal Health program which aims to support Aboriginal mothers, their partners and families through pregnancy. They are also a valuable resource for GPs to help with identification of Medicare item numbers. Allied Health is a core component of a patient centred primary health care system achieved through the provision of integrated health care. Whilst MLs have a responsibility to improve the patient journey through developing better coordinated and integrated services, trying to achieve this within a local health economy can often prove challenging. Many MLs have utilised the Patient Centred Health System model to promote service integration. This has been demonstrated to be highly effective in addressing health needs and also enhancing the patient experience (See 13

15 Allied Health Programs in the Primary Care Setting There are a number of primary health care programs currently delivered by Allied Health professions (see examples below). To fully utilise and coordinate services offered by Allied Health at a local level for the benefit of patients and the health care system alike, further initiatives are needed to better link services at a local level. Access to Allied Psychological Services (ATAPS) The ATAPS initiative is a Commonwealth Mental Health program that funds the provision of short term psychology services for people with Mental Health disorders. ATAPS enables GPs to refer patients with mild to moderate (high prevalence) disorders to Allied Health professionals for six sessions of evidence based mental health care. An option of a further six sessions exists pending a mental health review by a referring GP. Rural Primary Health Services (RPHS) The RPHS is a Department of Health and Ageing funded program that allows eligible participants to employ, contract or fund Allied Health professionals in rural communities. The aim is to increase the number and range of Allied Health services delivered in rural communities. It promotes an integrated approach to care by linking General Practice and Allied Health. Wellness Centres Wellness Centres aim to provide the highest quality exercise physiology and dietetics services to clients by providing support and education to promote active and healthy lifestyles and/or to support recovery from injury. All consultations are delivered by Accredited Exercise Physiologists (EPs) and an Accredited Practicing Dietitian (APD). Streams of care can include: exercise rehabilitation which promotes the activities of daily living and building confidence chronic and complex disease prevention and management aimed at improving physical condition, stamina and pain management techniques. Clinical Care Pathways Through engagement with local Allied Health peak bodies this ongoing project maps clinical pathways between primary, secondary and tertiary care using an innovative online tool. Local clinicians from General Practices and public and private hospitals, Allied Health professionals and relevant organisations are involved in improving the patient s path between services. This prevents professionals working in silos and creates simple and more efficient care pathways. Many Allied Health professions are especially keen to be involved. 14

16 Allied Health in Chronic Disease Management Allied Health Professions are key contributors in health promotion and disease prevention Primary health care has an important role in assessing, preventing and managing chronic disease. Despite the evidence of how to prevent chronic disease in the community there remains gaps and barriers in health promotion and preventative practices. The role of MLs is to facilitate change by developing partnerships with Allied Health professions and to coordinate and broker new preventative services and programs for the community. Primary health care providers have a central role in assessing population health needs and identifying at risk patients. While there has often been a tendency to provide short term interventions and follow up, intensive education and support through community based programs that include Allied Health, is recommended. Facilitating this is an important role of the Medicare Local which is reflected in their population health planning and service commissioning activity. Further information can be found at: Diabetes Co ordination and Assessment Service (DCAS) Diabetes Management can be delivered across all levels of care: intensive, active, proactive and preventative. To promote care across all these levels a number of Allied Health professions are involved, with services provided at a single diabetic clinic. The clinic can consist of a dietitian, diabetes educator, exercise physiologist, podiatrist and psychologist. Specific treatments include: acute diabetic foot wound management, functional foot assessments, education and prevention strategies and control of diabetes. Medicare Local funding has enabled improved access to these services and reduced waiting lists for clients with musculo-skeletal and orthopaedic conditions. Connecting Care Program The Connecting Care Chronic Disease Management Program is a NSW Health initiative that aims to link appropriate primary health care services to deliver more effective health management for patients with severe chronic disease, who are at high risk of unplanned hospital or ED presentation. The program delivers an integrated, patient-centred, holistic approach that addresses the patient s clinical and non-clinical needs. 15

17 Allied Health in the Medicare Benefits Schedule There are a number of Medicare item numbers that allow people to access Medicare rebates for Allied Health services following referral by a GP. The Allied Health services can fit under a variety of item numbers. For further information please liaise with the relevant Allied Health Peak Body (see section 5). Examples include, but are not limited to: 1. Chronic Disease Management (CDM) Medicare Benefits Schedule (MBS) The Chronic Disease Management (CDM) Medicare items on the Medicare Benefits Schedule (MBS) provide GP referral pathways to Allied Health professions, facilitating multidisciplinary team care arrangements to provide shared care for patients with chronic and complex conditions. These include the following professionals: Aboriginal Health Worker Audiologist Chiropractor Dietitian Exercise Physiologist Mental Health Worker Osteopath Podiatrist Psychologist Speech Pathologist Occupational Therapist Diabetes Educator Physiotherapist. As part of the Australian Better Health Initiative, AHPA developed a Chronic Disease Management resource package. This clarifies roles of selected Allied Health professions in chronic disease management, communication tips, schematics, templates and the MBS item numbers. 2. Rural Primary Health Services (RPHS) program The RPHS program aims to improve access to a range of primary allied health care services and activities for rural and remote communities. This program gives community-based primary health care services greater flexibility in the range of services they can offer, including health promotion and preventative health activities. The RPHS brings together the: More Allied Health Services program Regional Health Services program Multipurpose Centre program Building Healthy Communities in Remote Australia program. Further information on the Rural Primary Health Services (RPHS) program can be found at: ing.nsf/content/rural-primary-health- Services-Program 3. Speciality Medicare Rebates These items are specialty specific with eligibility criteria set out under different initiatives including for example: Better Start for Children with Disability Better Access to Mental Health Allied Health Follow Up Services for People of Aboriginal and Torres Strait Islander descent Access to Allied Psychological Services (ATAPS) Helping Children with Autism. ticket=cu5jtkd%2f0mg%3d&tabid=137& mid=982 16

18 Medicare Australia Eligible Allied Health Professionals Below is a list of the Allied Health professions that are able to register with Medicare Australia and therefore eligible to rebates if they meet specific criteria: Aboriginal and Torres Strait Islander health practitioners Aboriginal health workers Audiologists Chiropractors Diabetes educators Dietitians Exercise physiologists Mental health workers Accredited mental health social workers Occupational therapists Osteopaths Physiotherapists Podiatrists Psychologists Speech pathologists. Further information can be found at: Publishing.nsf/Content/health-medicarehealth_pro-gp-pdf-allied-cnt.htm 17

19 Pharmacy Pharmacists play a critical role in an integrated primary health care system as both a service provider and a trusted advisor to the community; and as such a signpost to appropriate services. It is important that MLs understand the role of pharmacists and establish effective working relationships with this profession. The classification system of pharmacy includes the following categories: Hospital pharmacist; with the sub categories of hospital pharmacists and pharmacy officer (for military based services) Industrial pharmacist Retail / community pharmacist; with the sub categories of retail/ community pharmacist and consultant pharmacist. The tasks and activities undertaken by pharmacists (with the exception of industrial pharmacists) can be considered in the following categories: Quality use of medicines activities (e.g. medication safety, institutional medicines policy management) Clinical services (e.g. medication review, pharmacist clinical interventions) Medicines procurement and distribution (e.g. purchasing, extemporaneous compounding) Teaching and research (e.g. undergraduate and post-graduate teaching) Administration and pharmacy management (e.g. resource and contract management, quality). Contemporary health care requires that the range of services offered by pharmacists needs to go beyond the traditional supply role. This can be seen in the following web links: Guiding principles for medication management in residential aged care facilities (RACF) ng.nsf/content/d9282d3ccc0bf2bcc A257AA A/$File/Guiding%20pri nciples%20for%20medication%20manag ement%20in%20residential%20aged%2 0care%20facilities.pdf The provision of pharmacy services in Aboriginal and Torres Strait Islander health services settings vices-for-indigenous-health-services.pdf Pharmacists have a role across the continuum of care between MLs and Local Hospital Networks, particularly in servicing patients with acute, chronic and complex disease. Pharmacists within MLs could provide patient-specific services such as: Identifying and addressing medication related problems (e.g. pharmacist clinical interventions) compilation of complete and accurate medication histories identification of patient-specific factors that affect their medication adherence/ assessment of a patient s current medication regimen (e.g. through Meds Check, Diabetes Meds Checks) In addition these pharmacists could provide support to other members of the healthcare team by: acting as a resource about the use of medicines developing relevant protocols and guidelines providing education about medicines to other health professionals Pharmacists are required to undertake continuing professional development training under AHPRA and the Pharmacy Board of Australia (PBA) registration requirements. Pharmacists can become accredited to deliver medication review services in RACFs and the home environment (Home Medicine Reviews HMRs) and need to meet specific eligibility requirements, be able to register with Medicare Australia and claim for these clinically focused services. In hospitals, pharmacists can work in a general dispensing and entry-level clinical roles, or seek additional training and education in order to work and practice at a more advanced or specialised level. QCPP Accreditation administered by the Pharmacy Guild of Australia allows for additional incentives to be paid to pharmacies. Top Tip Encouraging GP s to reach out to Pharmacists As the medicines expert of the patientcare team, pharmacists contribute to decisions about patients' treatment by reviewing their medicines, monitoring their progress and making sure they understand how to take their medicines correctly. Doctors can ask pharmacists for advice on the most appropriate dose or form of medicine or for their opinion about the use of certain medicines in a person with a particular clinical problem. Pharmacists working in both the community and hospital setting are available to be approached by healthcare professionals, patients and their families about how to use medicines safely and effectively. Further Information Society of Hospital Pharmacist of Australia Pharmaceutical Society of Australia The Pharmacy Guild of Australia YouTube: Pharmacy =2EnQUKgv1YM&list=SP A1E8EBD03 18

20 3 Allied Health, Requirements and Regulations 19

21 What is Allied Health? Although it is recognised the Allied Health workforce in Australia is comprised of a range of Allied Health practitioners who are each critical to the health of patients, for the purpose of this guide only Allied Health professions who work in Primary Care have been included. Allied Health is an umbrella term used to describe individuals who are trained to work individually or with others to support individuals achieve optimal health. Allied Health professions are distinct from medical, nursing or dental professionals. Their aim is to support diagnosis, recovery and quality of life. Access to Allied Health care can increase a person s mobility, independence and ability to care for themselves. It can also help reduce the risk of complications in chronic conditions, illness or injury. There are a wide range of services and supports available from a wide range of Allied Health professions which can often make it difficult to gain a full appreciation of the work of Allied Health. The term Allied Health can be used interchangeably to describe: The range and type of service/s provided (or not) The range of diagnostic, therapeutic or support provided (or not) The professional scope of practice. While there is no consistent definition of Allied Health, it is recognised that the Allied Health workforce in Australia is comprised of Allied Health professions and other Allied Health workers including technicians, assistants and support workers who all together help transform people s lives. Allied Health Professionals Allied Health Professionals are qualified to apply their skills to retain, restore or gain optimal physical, sensory, psychological, cognitive, social and cultural function of clients, groups and populations. Allied Health Professionals (eg: Physiotherapist, Audiologist, Dietitian) hold nationally accredited tertiary qualifications enabling eligibility for membership of their national self-regulating professional association or registration with their national Board. The identity of Allied Health has emerged from these Allied Health professions client focused, inter-professional and collaborative approach that aligns them to their clients, the community, each other and their health professional colleagues. Within these professions there are however still significant differences in 2 critical areas: Allied Health Regulation (see page 17) Allied Health Medicare eligibility (see page 12). Allied Health Workers Allied Health workers (eg: Health Promotion officers, Alcohol and Drug workers, Allied Health Assistants) provide vital support to clients and may or may not require academic qualifications. These workers operate alongside Allied Health professionals within a multidisciplinary team to support a person s health care. There are more than 90,000 Allied Health professionals (AHPs) working in Australia today, many of these highly trained professions work alongside doctors and nurses, providing quality primary health care for Australians. This represents 20% of the country's healthcare workforce a sizeable proportion which continues to grow. APHA 20

22 Allied Health Regulation Regulation is a system used to control standards of education and practice of a profession. The need for regulation is based solely on the need to provide quality practices and protect members of the public from harm. To be regulated, a profession must meet six criteria adopted by the Australian Health Minister s Advisory Council (AHMAC). Regulation may take one of several forms including: Registered, Self regulated, Negative licensing. Registered otherwise known as Statutory Regulation, is a form of regulation by an Act of Parliament. Only practitioners who have completed recognised educational qualifications and are bound by an enforceable code of ethics and code of practice can identify themselves as a practitioner. This provides the highest level of protection for members of the public. The registered professions are part of the Australian Health Practitioner Regulation Agency (AHPRA). The purpose of which is to protect the public by ensuring that only health practitioners who have the skills, qualifications and knowledge to provide safe care are registered. Under this national scheme practitioners once registered, renew yearly and can practice anywhere is Australia delivering benefits for both the public and practitioners. Self Regulated Self regulation is a system of controlling the activities of a profession by a governing body set up by the profession. This form of regulation is predicated on a single body setting standards for the profession. The majority of Allied Health professions are self regulated. This means the licensing of an individual to practise in a particular health profession. Different professions may use different terms such as accredited, certified, or credentialed. These professions are currently self regulated by their respective peak body to ensure suitably qualified professionals meet the requirements of fitness to practice, currency of practice and Continual Professional Development. There is however no enforcement to become a member of a respective peak body once qualified. This is one of the main reasons the National Alliance of Self-Regulating Health Professions (NASRHP) has called for a single regulatory system and model of authorised self-regulation (March 2012). One of the key pillars of the proposed model for all self regulating bodies is to ensure professionals can gain licensing without the current membership obligation, with a view to better protect the public through mitigating any risk to patient safety. Negative Licensing Negative licensing is a system where a practitioner can be banned from practicing by direction of the Health Care Complaints Commission after a complaint against a practitioner has been proven. This is a system that has been adopted in NSW and is under consideration in South Australia and Victoria. The NSW scheme is called a negative licensing scheme as it does not require unregistered practitioners to hold a license or pay a license fee but allows for action to be taken where an unregistered health practitioner has acted in a way that breaches the NSW code of conduct. Details of the NSW Code of Conduct for unregistered health practitioners, along with prohibition orders issued by the Health Care Complaints Commissioner can be accessed at the following address: ation-for-unregistered- Practitioners/default.aspx Currently the regulatory status for Allied Health Professions (which includes all professions in this guide) fall into 2 categories: Australian Health Practitioner Regulation Agency (AHPRA) formed in July Its operations are governed by the Health Practitioner Regulation National Law, which is in force in each state and territory (the National Law). This law means that, health professions are regulated by nationally consistent legislation under the National Registration and Accreditation Scheme (see The National Alliance of Self- Regulating Health Professions (NASRHP) formed in It aims to seek clarity regarding regulation for their respective professions and benchmark their self-regulatory environment. Table 1 highlights the regulatory status of those Allied Health professions which are included in Chapter 4. 21

23 AHPRA Registered Aboriginal and Torres Strait Islander Health Practitioner Psychologist Chiropractor Occupational Therapist Optometrist Osteopath Pharmacist 1 Physiotherapist Podiatrist NASRHP Regulated Audiologist Dietitian Diabetes Educator Exercise Sport Scientist Orthotist & Prosthetist Social Worker Speech Pathologist Table 1: Allied Health Regulation Despite the different regulation requirements it should be recognised that all Allied Health professions are striving for the same goal that patients have access to the right practitioners at the right time and in the right place to ensure they receive the most appropriate health service for the benefit of patients. Both regulated and self-regulated professions offer a high standard of unique skills in the primary care setting, however, this mix of accreditation can lead to unintended confusion, potential exclusion and a lack of clarify amongst stakeholders including patients, GPs and MLs. Options to overcome this confusion include: MLs ensuring that self-regulated professions receive the same acknowledgement as registered professions, thereby helping to reduce the unintentional two tier regulatory framework which does not support best practice in health service delivery All Allied Health professions - both registered and self-regulated - are included in ML workforce planning, innovation and reform initiatives. This includes NASRHP self-regulated Allied Health professions being allowed to participate in the governance of MLs, such as by sitting on boards and committees MLs supporting projects that encourage the progression of self-regulated professions. 1 Not included in Chapter 4 but can be found in Resources Chapter 7. 22

24 4 Allied Health Professions 23

25 Allied Health Professions Introduction Allied Health professions as discussed in this chapter are a core component of primary health care. They are an integral part of the multidisciplinary team which supports people with chronic and enduring heath problems and works toward better health and wellbeing. Definition As mentioned there is no one universal definition of an Allied Health profession but the following definition is widely accepted in Australia and has formed the basis for this guide. An Allied Health profession is one that has: a direct patient care role and may have application to broader public health outcomes a national professional organisation with a code of ethics/conduct and clearly defined membership requirements university health sciences courses (not medical, dental or nursing) at AQF Level 7 or higher accredited by their relevant national accreditation body clearly articulated national entry level competency standards and assessment procedures a professionally defined and a publicly recognised core scope of practice robust and enforceable regulatory mechanisms. and has Allied Health professionals who: are autonomous practitioners practise in an evidence-based paradigm using an internationally recognised body of knowledge to protect, restore and maintain optimal physical, sensory, psychological, cognitive, social and cultural function may utilise or supervise assistants, technicians and support workers. (AHPA) Further Descriptions This chapter provides information on each Allied Health profession listed over-page including: those services the profession offer credentials required by the profession top tip for engaging with the profession following feedback from the respective Peak body links to Peak bodies and other links for further information. A combination of the key challenges for these Allied Health professions and the identified enablers to support integration of Allied Health and MLs can be found in chapter 6. Table 2 is a list of those Allied Health professions included in the guide, their regulatory status and confirmation of whether they are members of AHPA. Aboriginal Health Worker Audiologist Chiropractor Diabetes Educator Dietitian Exercise and Sport Scientist Music Therapist Occupational Therapist Optometrist Orthotist/ Prosthetist Orthoptist Osteopath Physiotherapist Podiatrist Psychologist Social Worker Speech Pathologist Allied Health Professions Australia (AHPA) is the national voice for Allied Health and has members from both registered and self-regulated professions. It aims to represent its members through delivering high quality, competent and informed advice to government. Key: AHPA member Self regulated Registered Table 2: Allied Health profession status 24

26 Aboriginal Health Worker Aboriginal and Torres Strait Islander Health Workers (ATSIHWs) play a vital role in the primary health workforce. They provide clinical and primary health care for individuals, families and community groups including specialty areas of drug and alcohol, mental health, diabetes and eye and ear health. Their common objective is to assist the Aboriginal and Torres Strait Islander communities to take a strong role in controlling and managing their own health and lifestyles. Services An Aboriginal and/or Torres Strait Islander Health Worker (ATSIHW) is an Aboriginal and/or Torres Strait Islander person who is in possession of a minimum qualification (cert III) within the fields of primary health care work or clinical practice. ATSIHWs may perform a broad range of tasks including: the treatment of disease or injuries and maintaining health records acting as communicator and interpreter on behalf of clients and other health workers taking part in case management and follow up, either independently or with other health care providers providing health education to individual clients and health staff providing cultural education to people outside the cultural community providing life skills education, counselling and referral for crisis intervention in the community they serve providing input into the planning, development, implementation and monitoring and evaluation of all health programs in the community. ATSIHW are a unique profession where workers are able to do a variety of jobs which is often essential in rural and remote areas. They not only perform a comprehensive primary health care role (including clinical assessment, monitoring and intervention activities; health promotion and chronic disease management services) but also provide culturally safe health care suited to local health needs. Credentials The Aboriginal and Torres Strait Islander Primary Health Care qualification is nationally recognised and encompasses different levels (including cert II III IV) and varying requirements. Registered Training Organisations which provide the Certificate IV or higher in Aboriginal and Torres Strait Islander Health Practice must have the course accredited with the Aboriginal and Torres Strait Islander Health Practice Board of Australia, in order for participants to be registered with the AHPRA Board. This includes the Aboriginal and/or Torres Strait Islander Primary Health Care Practitioner (clinical role). Top Tip for Engaging with Aboriginal Health Workers Actioning the recent recommendations from Growing Our Future Health Workforce Australia. Factors include: recognition of the Aboriginal and Torres Strait Islander Health Worker workforce as a core part of the primary health care workforce prioritise the Aboriginal and Torres Strait Islander Health Worker workforce within Aboriginal and Torres Strait Islander health initiatives increase the Aboriginal and Torres Strait Islander Health Worker workforce to meet demand. Further information Peak Body - National Aboriginal and Torres Strait Islander Health Worker Association 25

27 Audiologist Audiologists are hearing specialists who manage hearing health. They specialise in assessment, prevention and management of hearing loss, deafness and related conditions, including tinnitus and balance disorders. Audiologists provide assessment to all ages, from infants to adults, and help through the application of technology, rehabilitation and therapy. Many Audiologists are also involved in research, helping to develop new hearing devices. Services Audiologists provide clinical services in hospitals and community health centres, hearing aid clinics, private practice, university clinics, and in some medical practices. They offer a range of services as seen in the table below: SPECIALIST Performed by Audiologists Advice to organisations and to other professionals, about hearing care Assessment for sensory aids, cochlear implants and other surgically implanted devices Assessment and therapy for people with tinnitus (noises in the ear or head) Counselling, and plans, to assist communication when hearing loss is present Complex assessments of: auditory neural pathways balance system of the ears central auditory processing hearing when other disabilities are present Full hearing assessments for babies and children Specialist hearing aid practice with children and people with complex hearing problems Credentials Audiology is a self regulated profession. There are mandated Continuing Professional Development (CPD) requirements to obtain a CCP (clinical certificate) which is audited every 2 years. Professionals are also required to practice with the Code of Ethics for Audiologists. Full membership of the Audiology Society of Australia requires proof of a certified university graduate certificate with tertiary qualifications in Audiology. Most job vacancies require a CCP for employment. Top Tip for Engaging with Audiology Raised awareness and increased knowledge on the impact of hearing loss. Audiology should be included in the development of Health Pathways as a high percentage of elderly patients will at some point require audiology services for hearing loss management. Further information Peak Body Audiology Australia YouTube Audiologist Specialist rehabilitation programs for people with complex hearing problems BASIC Performed by Audiologists and other practitioners Hearing aid fitting Standard audiometry tests Provision of hearing protection devices Noise measurement Workplace hearing tests Preliminary hearing checks Over 98% of profession hold membership of the peak body 26

28 Chiropractor A chiropractor is a government-registered and regulated, university-trained Allied Health care professional. Chiropractors complement medical services and promote general health by providing a primary contact with specific diagnostic focus on disorders relating to the spine and nervous system and advice on self care in lifestyle & movement factors. Services Chiropractic is a health care discipline based on the scientific premise that the body is a self-regulating, self-healing organism. They provide drug-free and manual therapies that can open collaborative opportunities for better patient outcomes. A chiropractor conducts thorough general examinations with particular focus on spinal and neuromusculoskeletal systems. They work with GPs in multidisciplinary settings to care for people with a wide range of acute or chronic disorders including neuromusculoskeletal disorders, such as: Acute or chronic back pain Extremity pain and dysfunction Poor mobility Degenerating posture Migraine headaches Osteoarthritis. Trigger points for referring patients to chiropractors include symptoms that may be of spinal origin, such as spine related pain, motion restriction and postural distortion. Chiropractors also place significant emphasis on wellness and prevention through provision of specialist lifestyle advice and movement. Referrals can therefore also be made to chiropractor for wellness and lifestyle advice including: Sport pain Cycling, Dancing and Running Sleep problems Gardening Bucket Back Workplace and backpack advice. Credentials For registration to practice, chiropractors must study full time at University for a minimum of 5 years, graduating with a 3year Bachelor degree followed by a Masters degree or a 5 yr double degree in Chiropractic Science and Clinical Science. To maintain quality and safety, chiropractors complete continuing professional development courses and seminars to upgrade and maintain their skills. These are essential according to required AHPRA registration standards. Case study: Straighten Up Australia Straighten Up Australia is an ongoing community service initiative of the CAA, and is an easy and enjoyable everyday program to improve your health and the way your body functions. Consisting of a set of simple exercises and taking just three minutes to complete, Straighten Up Australia will help improve posture, stabilise core muscle groups, enhance health and prevent spinal disability. The exercises can be undertaken by Australians of all ages with a special program tailored for children. Further information can be found at: e.cfm?section=sua Top Tip for Engaging with Chiropractors Increased understanding of the benefits chiropractic services offer Improved engagement at a practitioner level and Peak body level. This improvement and collaborative working would enable a greater understanding of the benefits and services leading to better informed decisions when developing and designing services in the MLs area. Further information Peak Body - Chiropractors Association of Australia 53% of profession hold membership of the peak body 27

29 Diabetes Educator Diabetes educators specialise in the provision of diabetes self-management education for people with diabetes. The discipline is about assisting people with diabetes, their families and carers to gain the knowledge, skills, motivation and confidence to manage their condition. Diabetes education assists people with diabetes to Know what to do, Know how to do, Want to do it, Be able to do it, Recognise when to seek assistance. Services Diabetes Educators provide support and education for people with diabetes (including gestational diabetes) integrating clinical care, self-management education, skills training and disease specific information to motivate patients to: understand diabetes and make informed lifestyle and treatment choices incorporate physical activity into daily life use their medications effectively and safely use glucometers and monitor and interpret blood glucose levels manage hypoglycaemia and hyperglycaemia initiate and manage safe and effective insulin pump therapy. It is recommended that GPs refer a patient for diabetes education when: They are first diagnosed with diabetes Starting blood glucose monitoring at home Introducing diabetes tablets or insulin therapy Having difficulties reaching treatment targets and management goals such as blood glucose Having frequent or severe episodes of low or high blood glucose levels Lifestyle or life stage changes such as when starting an exercise program, planning to travel or starting school Planning pregnancy, during pregnancy and after delivery Feeling stressed or burnt out by diabetes. Credentials Diabetes educators who meet all the requirement of the Credentialling Program are recognised for their commitment to ongoing professional development and for their knowledge, skills, expertise and experience in the field of diabetes education by being awarded status as a Credentialed Diabetes Educator (CDE) for three (3) years. CDEs who meet the Re-Credentialing Program s prescribed criteria can apply to have their CDE status renewed for another three (3) years. A CDE is one who meets the Australian Diabetes Educators Association (ADEA) standards of practice, has completed a post graduate certificate in diabetes education and management from an ADEA accredited University, complies with the ADEA professional development and clinical experience requirements and is eligible to practice in their primary discipline as: Registered Nurse Accredited Practising Dietitians Registered Medical Practitioners Registered Pharmacists accredited to conduct medication management reviews Registered Podiatrists Accredited Exercise Physiologists. Top Tip for engaging with Diabetes Educators Support in establishment of appropriate referral pathways To support implementation of referral pathways for GP s to Diabetes Educators including promotion of their valuable services offered. This will facilitate innovative health partnerships to improve health outcomes and reverse the impact of preventable chronic disease in the communities, (especially obesity leading to type II diabetes). Further information Peak Body - Australian Diabetes Educators Association 100% of credentialed professionals hold membership of the peak body 28

30 Dietitian Accredited Practising Dietitians (APDs) are experts in food and nutrition. They can advise patients on the specific nutritional management of many heath conditions such as diabetes, overweight and obesity, cancer, heart disease, renal disease, gastro-intestinal diseases and food allergies. Timely intervention by a dietitian can reduce the risk of developing chronic disease. Services APDs working in the primary care setting offer a broad range services. These may include: Community and Public health Nutrition including consultation to residential aged care facilities, child care centres and group homes for people with disability regarding clinical care, staff training, menu assessment and planning and compliance monitoring of therapeutic diets Medical Nutrition Therapy (clinical care) with patients including assessment and nutritional education/counselling, enteral / parenteral nutrition monitoring and evaluation Food service Management which can be at Community Health centres running nutrition education sessions ( such as supermarket tours, cooking classes, diabetes education and cardiovascular education). Although there are a wider range of triggers for referring patients to a dietitian key factors include: Significant weight change Failure to meet nutrition needs Recent poor food intake, poor appetite, or difficulty preparing or eating food Changes in medication Periodic review of medical nutrition therapy. Credentials To be eligible to provide services under the CDM Medicare items, a dietitian needs to be an APD as recognised by the Dietitians Association of Australia (DAA). Please note: Qualifications in human nutrition science alone are not sufficient to meet the APD program requirements as they do not include training in all three dominant areas of practice i.e. individual case management of medical nutrition therapy (clinical care), community and public health nutrition, and food service management. Dietitians may call themselves nutritionists, but the reverse is not true in Australian practice. APD must uphold the following requirements to maintain registration: Australian recognised dietetic qualifications Completion of a minimum of 30 hours per year of continuing professional development Commitment to the DAA code of professional conduct and statement of ethical practice Agreement to comply with auditing of APDs. Top Tip for engaging with Dietitians MLs to apply for more relevant community grants MLs could be a focus for integrated multidisciplinary community projects led by APDs which would meet unmet nutritional needs of the community by attracting community grants. Examples of these include: Malnutrition screening and assessment of older people in the community Nutrition programs for the homeless. The disciplines involved could include APDs, GPs, nurses, care workers, food service, and other Allied Health. A collaborative care model could include a few or many organisations. Further information Peak Body Dietitians Association of Australia Over 75% of profession hold membership of the peak body 29

31 Exercise Physiologist Exercise physiologists (EPs) provide exercise and lifestyle support for chronic diseases and injuries. The primary aim of service delivery is to encourage lifestyle changes that are sustained in the long term. EP s must be accredited with ESSA to enable them to access Medicare and Private Health funds etc. Services EPs offer a range of services which include individual and group based lifestyle counselling, self-management support, exercise advice and monitoring of behaviour changes with a view to promoting independent lifestyle management. The primary modes of treatment for EPs are behavioural coaching, health education, exercise counselling and physical rehabilitation. EPs specialise in exercise prescription including individualised exercise programs, promoting leisure-time and incidental activity, and counselling to reduce sedentary behaviours. Initially a range of assessments would be conducted to ensure the activity prescription is safe, effective and likely to be maintained in the long term. The patient will then be given the option of receiving a home based program, ongoing support in an exercise clinic, or a referral to an appropriate local physical activity provider with follow up help provided by the EP. EPs work with people on a range of conditions, including: Cardiovascular disease Diabetes Osteoporosis Depression Cancer Arthritis Chronic obstruction pulmonary disease (COPD) Chronic Pain. An EP could be referred to either at the point of initial diagnosis, following the identification of risk factors or for promoting general wellbeing. Credentials EPs undertake mandatory continuing education every year to retain accreditation with ESSA. All exercise physiologists receive specialist training in chronic disease management and behaviour change. EP's must be accredited with Exercise & Sports Science Australia (ESSA) to enable them to access Medicare, Private Health funds, DVA etc. To become accredited, on completion of their degree, EPs must meet the accreditation requirements and hold a current First Aid and CPR certificate. To maintain accreditation, they must complete yearly continuing education and hold a current CPR certificate. Top Tip for Engaging with Exercise Physiologist Support business practices understanding Medicare rebates By providing local one-to-one business education on item numbers/funding available, this will support and increase the understanding of what businesses can claim in meeting the patients health needs. Further Information Peak Body - Exercise and sport Science Australia YouTube AEP s and MLs BH4 More than 70% of the profession hold peak body membership 30

32 Music Therapist Music Therapy is a research-based practice and profession in which music is used to actively support people as they strive to improve their health and wellbeing. Music therapy is the intentional use of music by a University trained professional who is registered with the Australian Music Therapy Association Inc. Registered Music Therapists draw on an extensive body of Research and are bound by a code of ethics that informs their practice. Music therapists are committed to supporting people of any age and ability regardless of musical skill, culture or background. Services Music Therapists incorporate a range of music making methods within and through a therapeutic relationship. They are employed in a variety of sectors including health, community, aged care, disability, early childhood, and private practice. Music Therapy is different from music education and entertainment as it focuses on health and wellbeing. Music Therapists do not provide a primary care diagnosis. They do, however, work as part of an Allied Health team in a variety of settings including hospitals, nursing homes, schools and the community, delivering tailor-made programs to meet specific needs. When working with all populations, music therapists use music-based interventions to provide a range of cognitive, physical and socio-emotional goals which are determined through an assessment by the RMT. These interventions may include song writing, improvisation, receptive listening, and other specialty techniques. Sessions may be individual or group including; writing songs for or with clients, playing instruments and improvising to create original pieces, listening to music or singing. Areas of care that regularly utilise music therapy services include: Palliative care Disability Aged care Rehabilitation Mental health Neo-natal care and general paediatrics. Credentials Registration with the Australia Music Therapy Association (AMTA) is granted when applications prove their Bachelor or Masters degree from the relevant accredited universities. RMTs must participate in Continuing Professional Development which is monitored by AMTA Inc. CPD points must be submitted every 5 years and ongoing registration depends on these submissions. Top Tip for engaging with Music Therapists Collaborative approach to development of strategic priorities MLs to consult broadly with Allied Health, to prevent any assumptions being made and enable a clear understanding of how Allied Health fit into their equation. A clear understanding of the breadth and depth of treatment offerings are critical to decision making. Further Information Peak Body - Australian Music Therapy Association Membership is especially high due to employers insisting on correct qualifications and membership with AMTA. Look for the RMT status which indicates approved tertiary training and ongoing approved CPD 31

33 Occupational Therapist Occupational therapists (OTs) assist people of all ages to overcome limitations caused by injury or illness, psychological or emotional difficulties, developmental delay or the effects of aging. They assist people to move from dependence to independence, maximising personal capability. Occupational therapists often work in a multidisciplinary team, assisting people to overcome a wide range of conditions including: diabetes, CVD, stroke, arthritis and stress. Services Within the primary health care sector occupational therapists offer services to patients in the community through a variety of avenues including: private practice, GP/other health care practice or Medicare Locals as contractors or employees. They can also be accessed through community managed organisations (non-government organisations) or outreach from a public health facility where community health services are provided. Occupational therapists provide services across the life span. They work in the primary health care setting to provide services in chronic disease management, rehabilitation, mental health, and physical disability. Services may include specialised assessment, intervention / therapy, and team consultation. Services can vary depending on the occupational therapist s area of practice. Examples include: activities of daily living and functional assessment driving assessment equipment prescription and training environment modification specialised intervention, e.g. child development (motor skills, cognitive skills, play skills, specific skills, e.g. handwriting) rehabilitation (functional and occupational rehabilitation) mental health intervention (FPS) post hospital discharge follow up cognitive assessment and intervention. Occupational therapists work within a bio psychosocial framework addressing a range of components including motor (gross / fine / balance/biomechanics), cognitive, social, psychological abilities. Credentials Occupational therapists are required to complete mandatory continuing professional development according to AHPRA registration requirements. AHPRA has determined specialised professional "accreditation" is not available for occupational therapists however, occupational therapists claiming Medicare rebates require "accreditation" as follows: Focussed psychological strategies (FPS) under Better Access requirements. The requirements for the Better Access program are to have registration without restrictions (AHPRA), satisfactory evidence of two years supervised practice as an occupational therapist working in mental health. Satisfies the competency units described in the OTA Australian Competency Standards for Occupational Therapists in Mental Health 1999 CDM requirements Chronic Disease Management. Allied Health professionals need to meet specific eligibility requirements, be in private practice and register with Medicare Australia. Top Tip for engaging with Occupational Therapist Local engagement with occupational therapist Research and provide information to local GPs on OT services that are available in the area to ensure GPs have the correct contact details and what programs they offer for whom. Further Information Peak Body Occupational Therapy Australia YouTube Because of Occupational Therapy Ud5Fp279g4Y 32

34 Osteopath An osteopath provides manual therapy to treat a wide variety of musculoskeletal problems and other functional disorders of the body, taking a whole of body approach. Osteopaths are primary care practitioners, and are trained to be able to recognise conditions that require medical referral. They are also trained to carry out standard medical examinations of the cardiovascular, respiratory and nervous system. Services Osteopathy is a form of manual healthcare which recognises the important link between the structure of the body and the way it functions. Osteopaths focus on how the skeleton, joints, muscles, nerves, circulation, connective tissue and internal organs function as a holistic unit. Using skilled evaluation, diagnosis and a wide range of hands-on techniques, osteopaths can identify important types of dysfunction in your body. Osteopathic treatment uses techniques such as stretching and massage for general treatment of the soft tissues (muscles, tendons and ligaments) along with mobilisation of specific joints and soft tissues. In Australia, osteopaths are university trained in anatomy, physiology, pathology, general medical diagnosis and osteopathic techniques. Osteopaths are primary healthcare practitioners and are trained to recognise conditions which require medical referral. They are also trained to perform standard medical examinations of the musculoskeletal, cardiovascular, respiratory and nervous systems. Although there are currently no specialties for osteopaths; as musculoskeletal practitioners many osteopaths have undertaken further training and have clinical interests in pain management, sports, paediatrics and rehabilitation. Credentials In Australia, all osteopaths are required to be government registered practitioners under the national registration scheme APHRA. As such they are required to comply with all the codes and guidelines associated with such registration. Top Tip for Engaging with Osteopaths Information Technology Support Assistance around e-health requirements and infrastructure including: access to shared resources for improvement of service provision, directories and infrastructure. Further Information Peak Body Australia Osteopathic Association YouTube What is Osteopathy? UI 1,700 practice across Australia 33

35 Optometrist Optometrists are registered health professionals concerned with the health of the eyes and related structures. They are trained to prescribe spectacles and contact lenses to improve vision, and to assess, diagnose, manage and treat various eye conditions and diseases. All practising optometrists in Australia must be registered with the Optometry Board of Australia (OBA). Services Optometrists provide a broad range of primary eye care services, including: refractive testing and comprehensive vision checks prescription of glasses or contact lenses assessment, management and referrals of ocular conditions such as dry eye and allergy assessment and treatment of vision problems in children co-management, primary care monitoring and treatment of patients with ongoing eye conditions, such as those caused by diabetes testing and monitoring: visual acuity testing, slit lamp examination, visual fields testing assessment and reporting on fitness to drive. Registered optometrists with correct training are able to prescribe specific topical medications for the management of ocular conditions or disease. These optometrists can work within a broader scope of practice including: examining patients for signs of ocular disease, including superficial infection and anterior eye disease, and where necessary, treating or referring treating ocular conditions such as dry eye and allergy managing glaucoma (often done in comanagement with Ophthalmologists) providing after-care for cataract surgery. Optometrists work with and refer to ophthalmologists, GPs, or low vision services as required in the community. Many optometrists do additional training and have special expertise in areas including: Paediatric optometry Vision therapy in children Contact lenses Colour vision Occupational vision testing Rehabilitation for vision problems. Credentials In Australia, all optometrists are required to be government registered practitioners under the national registration scheme APHRA. As such they are required to comply with all the codes and guidelines associated with such registration. These include: adherence to practice requirements; possession of appropriate professional indemnity insurance; meeting specified continuing professional development requirements; maintaining good character; and regular cardiopulmonary resuscitation training. Top Tips for Engaging with Optometrists Increased networking and interdisciplinary education opportunities These would support and strengthen networks and collaboration between optometrists and other relevant primary care providers (optometrists primarily work with GPs and pharmacists at a primary care level) and encourage locally-relevant referral pathways relevant to primary eye care to be established and adhered to. Further Information Peak Body Optometrists Association Australia 34

36 Orthoptist Orthoptists are eye healthcare professionals who are trained in the assessment and treatment of patients with eye disorders. Orthoptists are uniquely skilled in ophthalmic diagnostic services and specialise in children s vision, eye movement disorders and low vision care. They work across a range of settings including hospitals, private specialist practices and research centres. Services Orthoptists offer assessment and management of various ocular and vision disorders. These can include: Paediatrics: Assessment and management of amblyopia (lazy eye) and strabismus (misalignment of eyes) Ocular Motility: Assessment and management of adults and children with eye movement disorders, strabismus (misalignment of the eyes) and visual consequences such as diplopia (double vision) Screening: Screening for ocular conditions, in particular vision screening for children or elderly and diabetic retinopathy screening Low Vision: Assessment and management of patients with low vision/vision impairment Rehabilitation: Assessment and management of patients with neurological deficits (e.g. loss of visual field subsequent to stroke) Occupational and Driving Evaluation: Ocular assessment for the evaluation of occupational standards and/or driving. Credentials A recognised orthoptic qualification which is currently offered at 2 universities La Trobe University and University of Sydney. Orthoptists must be registered with the Australian Orthoptic Board to qualify for Medicare benefits. This requires CPD to be maintained. Top Tip for Engaging Orthoptists Improved Business Support. As this is a relatively new area for orthoptists support in further developing their business in relation to MLs goals is important. How businesses can become a part of and engage with MLs is a priority. Further Information Peak Body Orthoptics Australia YouTube Care to go beyond: Orthoptist dvq 35

37 Orthotist/ Prosthetist An Orthotist's role is to assess, prescribe, apply and provide education regarding the use and care of an appropriate orthosis that serves the individual's requirements. However, a Prosthetist is clinically responsible for assessing, manufacturing and fitting various types of upper and lower limb prostheses (artificial limbs). Services Prosthetists are responsible for the clinical care and the fitting of artificial limbs for amputees. Prosthetic services are provided immediately postoperatively in hospitals as part of the rehabilitation program for amputees. These services continue throughout the amputee's life. Orthotists are responsible for the fitting of devices which apply external forces to the body for the purpose of support and alignment, reducing pain or enhancing mobility. The delivery of orthotic services also occurs in acute hospital settings for a broad range of clinical presentations, such as spinal trauma. Orthotic services are also provided for rehabilitation and ongoing care for clients with a diverse range of presentations such as cerebral palsy, polio, and sporting injuries. Orthotists practice in both short-term acute and long-term rehabilitation settings. Orthoses may be provided for all parts of the body, ranging from complex spinal braces following road trauma, to conditions requiring the application of foot orthoses. Specialisations within these services can include paediatrics, neurology and high end products (bionic hands and computerised knee units). Credentials The minimum entry into profession is a relevant bachelor degree and is what most insurance companies and public hospitals require. However normally they will also require Peak Body membership. It is self-regulated profession so requirements include upholding the constitution, CPD and professional standards. Top Tip for Engaging Orthotists/Prosthetists Better understanding of the profession and services offered Through better understanding it would automatically make it easier to include and support the profession. MLs could raise the profile of the profession with GPs which would effectively lead to earlier timely referrals. Further Information Peak Body The Australian Orthotics Prosthetics Association over 80% of profession hold membership of the peak body 36

38 Physiotherapist Physiotherapists use a holistic, person-centred approach to support patients across the lifespan to maximise their mobility and functional capacities, and therefore their independence and general wellbeing. As well as treatment they also advise the patients on ways to manage their condition and show them how they can prevent further pain or injury. Services Physiotherapists assist patients with musculoskeletal, cardiothoracic and neurological problems. They provide lifestyle modification and selfmanagement advice; manual and electrophysical therapies; prescribe aids and appliances; prescribe exercise and supervise exercise classes; provide physical activity counselling and movement training; and provide health promotion and prevention activities and advice. Physiotherapists treat a range of chronic conditions, often as part of multidisciplinary teams, including: Cardiovascular disease Chronic obstructive pulmonary disease Diabetes Osteoarthritis Osteoporosis Obesity Hypertension Stroke Physiotherapists are uniquely placed to address risk factors for chronic conditions. They have knowledge of the complexities of co-morbidities and physical limitations in people with chronic conditions and are trained to design programs that respond to these complications. Credentials Physiotherapy courses may be entered through a university bachelors, masters or professionals doctorate program. In Australia, practising physiotherapists are required to be registered under the National Physiotherapy Board of Australia. Members of the Australian Physiotherapy Association are required to participate in the Association s continuing professional development program. Top Tip for Engaging with Physiotherapists Improved Physiotherapy primary care involvement Many professionals are keen to be involved if aware of how they can become involved. It is essential MLs reach out to build their own Allied Health professional database especially when there are so many different specialities within physiotherapy. Further Information Peak Body Australian Physiotherapy Association 37

39 Podiatrist A podiatrist deals with the prevention, diagnosis, treatment and rehabilitation of medical and surgical conditions of the feet and lower limbs. They implement risk prevention strategies to prevent foot pathologies, provide treatment that delays or minimises the need for hospitalisation and/or invasive treatment, and create therapeutic health care plans, which maximise a patient s quality of life. Services Podiatrist's are health professionals who specialise in the examination, treatment and management of the lower limbs including the foot and ankle. They may treat patients with bone and joint disorders including: Arthritis Soft tissue and muscular pathologies Neurological Circulatory diseases. Podiatrists can diagnose and treat complications that affect skin and nails, corns, calluses and ingrown toenails, foot injuries and infections. Triggers for referral to a podiatrist include: Patient with diabetes and peripheral vascular disease, or neuropathy Clinical diagnosis or history of foot or lower limb deformity Clinical diagnosis of falls. For conditions such as recurring sprains and chronic pain, podiatrists may prescribe foot orthoses. The Podiatrist's scope of practice includes areas such as paediatrics, diabetes, sports injuries, structural problems, the treatment of the elderly as well as general foot care. Credentials Podiatrists are university trained professionals, required to undertake a minimum of 20 hours of CPD per year. To be eligible to provide services under Medicare, podiatrists must be registered with AHPRA under the National Podiatry Board of Australia and meet the required standards. There are no state/territory based podiatry boards. Most private health insurers provide rebates for podiatry services. Registered podiatrists practise under a strict code of ethics and adhere to compulsory guidelines on infection control. Top Tip for Engaging Podiatrists Encourage support in Podiatrists as a way of avoiding hospitalisation. Australia has the second highest rate of unnecessary lower limb amputation in the developed world despite good access to doctors. Best practice suggests good access to podiatry makes a significant difference. Further Information Peak Body Australasian Podiatry Council (APodC) YouTube There are 3 video announcements on the association website including: Need to see a podiatrist Get feed wise in your workplace Children foot health 38

40 Psychologist Psychologists study the cognitive, emotional, and social aspects of behaviour. They provide services in a range of settings including hospitals, clinics, schools, and private practices. Health psychologists specialise in understanding the effects of psychological factors related to health and illness. They use evidence-based interventions, such as cognitive behavioural therapy, to help people adjust to acute, chronic, or complex medical conditions; and also assist people with mental illness. Services Clients can range across all ages from preschool to the older Australian. There are nine areas of practice endorsed by the Psychology Board of Australia: Clinical neuropsychology, Clinical psychology, Community psychology, Counselling psychology, Educational and developmental psychology, Forensic psychology, Health psychology, Organisational psychology and Sports and exercise psychology. Their role includes: Working with medical practitioners and other health care professionals to implement patient programs to promote health, prevent illness and to facilitate chronic disease self-management Working with individuals to make lifestyle changes to maximise health and functional outcomes Addressing emotional and behavioural factors related to adjustment to chronic conditions or injury Helping patients with life-threatening conditions to manage pain, cope with medical interventions and the side effects of interventions Assisting individuals to adhere to treatment regimens Providing support to patient s families and carers. Psychologists provide services for CDM and other Medicare programs including ATAPS. Credentials A registered psychologist must have completed a four-year Australian Psychology Accreditation Council (APAC) accredited university degree, followed by an APAC accredited post graduate degree or two years of supervised professional training. As a condition of registration through AHPRA, psychologists must strictly adhere to professional and ethical guidelines. Top Tip for Engaging Psychologists Improved practice support This would include support on Medicare registration, claiming, e health registration and overall navigating between the various Medicare programs. Further Information Peak Body Australian Psychological Society 39

41 Speech Pathologist Speech pathologists provide services to people with communication and swallowing difficulties (dysphagia). Communication disorders may affect speech, fluency, hearing, reading and writing, and language skills. Swallowing disorders may affect a person s ability to chew, drink and eat certain foods and/or to swallow safely. Services Speech pathologists in the primary care setting diagnose and treat communication disorders, including difficulties with speech, language, social communication, swallowing, fluency, voice and multi-modal communication. They work with clients across the lifespan, including people who have difficulty communicating because of developmental delays, stroke, brain injuries, learning disability, intellectual disability, physical disabilities (such as cerebral palsy), dementia, progressive neurological disorders and hearing loss, as well as other problems that can affect speech, language and swallowing. Within the primary care setting they can work in a variety of settings including residential aged care facilities, rehabilitation centres, community health centres, early intervention services, disability services, mental health services, non-government organisations, juvenile justice and private practice. Speech pathologists use an evidence based practice approach to the assessment, intervention, and outcome measurement in the provision of speech pathology services. Within the broader community they support and educate professionals, families and carers to improve their understanding of communication disorders. This may include working with teachers on how to best support a child to participate in the classroom, assessing and prescribing Augmentative and Alternative Communication (AAC) devices or recommending a modified diet for a client with a swallowing problem. Credentials Speech Pathology Australia (SPA) practicing members must have completed an accredited university course and demonstrated recency of practice. SPA s Professional Self Regulation (PSR) program provides a framework for acknowledging participation in activities which maintain currency of and enhance the speech pathologist s professional knowledge and skills. SPA members who have met the requirements of the PSR program are eligible to use the Certified Practising Speech Pathologist (CPSP) title. SPA strongly encourages members to earn CPSP status to demonstrate to clients, employers, colleagues, peers and the public that they have a commitment to updating and extending their professional practice abilities. Top Tip for Engaging Speech Pathologists Engage with SPA and their ML webpage SPA is developing a ML webpage for which MLs can submit information and will link to each MLs webpage. Information regarding engagement events, surveys, information sessions, calls for EOI for Clinical Advisory Groups, or other committees, membership of ML will be distributed to SPA members via SPA. Further Information Peak Body Speech Pathology Australia 40

42 Social Worker Social workers engage with people of any age to achieve the best possible levels of personal and social well-being. This happens by working on personal and other issues identified by the individual or family as needing change and by connecting them with supports to build on strengths and emerging improvements. Social workers have a sound knowledge of human behaviour and development, life cycle stages, families and social networks, disability and health, including mental health. They also understand the issues that contribute to vulnerability and resilience. Services Social workers are employed in many public, non-government and private organisations as well as in private practice. From a primary health perspective, typical social worker services include: Personal and family counselling or therapies and group work Service information and facilitated referral or linking to relevant services Service coordination or care management Advocacy with individuals, families and particularly people experiencing social disadvantage. At the outset, the social worker undertakes a comprehensive psychosocial assessment with the person. They then assist the person to regain or achieve their desired outcomes through evidence based interventions and strategies. An important element of this process is assessing whether progress is being made. Among the issues social workers can become involved in and which may affect a person s health is personal or family dysfunction, parenting difficulties, mental health problems, alcohol or drug addiction or unstable accommodation arrangements. In addition, Accredited Mental Health Social Workers (mostly private practitioners) have acquired additional specialist training and skills in assisting people with diagnosed mental health conditions. If the person is referred by a GP, Psychiatrist or Paediatrician, the AMHSW will ensure that they collaborate with the medical practitioner as well as the person to achieve improvements. Credentials All university Social Work degrees must be accredited by the Australian Association of Social Workers. They are either a four year undergraduate degree or a two year Masters option if accompanied by a relevant undergraduate qualification. Social workers must comply with the profession s Code of Ethics and its Practice Standards. Social Work is a self-regulated profession which is in the process of seeking registration. Top Tip for Engaging Social Workers Social workers have knowledge and skills in changing the personal and social determinants of health that affect health outcomes. These involve factors in a person's situation or environment as well as psychological well-being. MLs can engage social workers through Better Access and ATAPS program in health planning for an individual when determining the health needs of the community and subsequent service delivery planning. Note: social workers have been trained in cross-cultural practice. Further Information Peak Body Australian Association of Social Workers over 65% of profession hold membership of the peak body 41

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44 5 Allied Health Peak Bodies 43

45 Allied Health Peak Bodies and Organisations What are peak bodies? A peak body is defined as a state, territory or national non profit organisation established to cater for the needs, interests and aspirations of its members who all have a common interest. What is the role of a peak body? Peak bodies are member-based associations, with the primary purpose of providing services of a nature and quality that ensure maximum member loyalty. This includes addressing the needs, interests and aspirations of the members. Some peak bodies have both individual members and member-organisations which mean they need to ensure that the range of services they provide meet the needs, interests and aspiration of both membership groups. Peak bodies are always member-based organisations. They exist to serve the needs, interests and aspirations of their membership base. Services include coordination, advocacy and representation, research and policy development and the provision of products/services, eg indemnity insurance (see page 45 for full list for peak body services) How can Allied Health peak bodies and MLs work collaboratively? Peak bodies are keen to establish effective joint working relationships with MLs. Opportunities for greater collaboration could be considered at both peak body and regional branch level where appropriate. Such collaboration should build on collective strengths and promote collective action. Both MLs and Allied Health peak bodies should ensure they do not duplicate nor dilute the service offered by each party (e.g. ADA provides support to practices with regard to accreditation and many peak bodies provide CPD). Similarly MLs should consider how to establish their own mechanisms for bringing Allied Health services together on a regional and sub-regional level and expanding their own membership base. National Allied Health peak body organisations Peak bodies usually operate on a state, territory, or national basis and many state and territory peak bodies are themselves members of their national organisations: AHPA is the peak body for Allied Health professions SARRAH s membership includes rural and remote Allied Health professionals IAHA is the peak body for Indigenous Allied Health professionals and students. In the Australian context Allied Health peak bodies are organisations that represent the interests of the nonmedical health professions sector, particularly to the Commonwealth Government, and provide a vehicle for liaison and discussion between each profession. Each has internal systems and networks for liaising with their members, ensuring support and access to a range of resources for their members and they commonly offer information and resources to the public. This chapter provides information on the peak bodies and a summary of services for each of the Allied Health professions detailed in chapter 4. It also includes the national Allied Health organisations as above. In addition it identifies the respective peak body search function for professionals at a local level. 44

46 Allied Health Peak Bodies Aboriginal Health Work The National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA) is the professional association for Aboriginal and Torres Strait Islander Health Workers in Australia. It was established in 2009, following the Australian Government s announcement of funding to strengthen the Aboriginal and Torres Strait Islander health workforce as part of its Closing the Gap initiatives. Contacts: (free call from landline) Website: Diabetes Educator The Australian Diabetes Educators Association (ADEA) is the leading Australian organisation for health care professionals providing diabetes education and care. The ADEA actively promotes evidenced-based best practice diabetes education to ensure optimal health and well being for all people affected by, and at risk of, diabetes. It is a national association with branches in all Australian states and territories. Contacts: Website: Music Therapy The Australian Music Therapy Association Inc (AMTA Inc) is the peak body for music therapy in Australia aimed at promoting the planned and creative use of music to attain and maintain health and well being. The aim of the AMTA is to establish and maintain professional standards for music therapists in Australia and promote and encourage training in music therapy to the highest possible level. Contacts: Website: Audiology Audiologists in Australia are represented professionally by the Audiological Society of Australia Inc (ASA). ASA has a current membership in excess of 98% of audiologists. The Audiological Society of Australia works to pursue and promote the knowledge and practice of audiology as well as furthering the advancement of the member's professional interests. It is a national association with the head office in Melbourne. Contacts: Website: Chiropractor The Chiropractors Association of Australia Limited (CAA) is the peak body representing chiropractors. By offering expert drug-free spinal health care and lifestyle advice, chiropractors help Australians lead and maintain healthy lives. The CAA is the largest chiropractic health body in Australia, and coordinates its efforts with its 8 autonomous CAA state & territory organisations. Contacts: Website: Dietitian Dietitian Association of Australia (DAA) is the leading nutrition organisation in Australia. It is a not-for-profit, professional member association. DAA is devoted to supporting its members and advocating for better nutrition and health for all Australians. It provides both information for other health professionals, professional support to members and nutritional education for the public. Contacts: Website: www. daa.asn.au Exercise & Sport Science Exercise and Sports Science Australia (ESSA) is the peak professional organisation committed to establishing, promoting and representing the career paths of tertiary-trained exercise and sports science practitioners. ESSA provides essential information about the industry, association and education opportunities. Contacts: Website: Occupational Therapy Occupational Therapy Australia (OTA) is the single, national professional organisation for occupational therapists. The members are qualified occupational therapists employed throughout the public and private sectors who provide health care, vocational rehabilitation and consultancy to clients. It has its national head office in Melbourne, and divisional offices are located in NSW, Victoria, Queensland and South Australia (part time). An Executive Director is also located in the national office to provide support for WA, Tasmania, NT and ACT. Contacts: Website: Optometry Optometrists Association Australia (OAA) is the national peak body for optometrists in Australia and over 93% of registered optometrists are members of the Association. OAA provides a range of services and benefits for members, ranging from political representation to continuing professional development and clinical and nonclinical publications. The Association is committed to assisting optometrists deliver quality eye and vision care services across Australia. Contacts:

47 Orthoptics Orthoptics Australia (OA) is a national organisation representing members in all states of Australia. OA strives to promote and advance the discipline of orthoptics in public hospitals and ophthalmology practices and to actively seek and implement career and work benefits and opportunities for its members. The OA is a national organisation with state and territory based councils. Contacts: Website: Orthotic/ Prosthetic The Australian Orthotic Prosthetic Association Inc. (AOPA) is the peak professional body representing orthotists and prosthetists within Australia. AOPA aims to promote the training, education and professional status of orthotists and prosthetists throughout Australia. The Association is committed to provide continuing education of the highest standard to keep members and industry colleagues up to date on all matters relevant to the profession. Contacts: Osteopathy The Australian Osteopathy Association (AOA) is the peak body representing the interests of osteopaths, osteopathy as a profession and consumer's right to access osteopathic services. The AOA core work is liaising with state and federal government regarding professional, educational, legislative and regulatory issues as well as private enterprise. The AOA is a national organisation with state and territory based councils. Contacts: Website: Physiotherapy The Australian Physiotherapy Association (APA) is the peak body representing the interests of Australian physiotherapists and their patients. The APA is committed to the concept of continuing professional education through offering members advanced training. The APA is a national organisation with non-autonomous state and territory branches and specialty subgroups. Contacts: Website: Podiatry The Australasian Podiatry Council (APodC) is responsible for preparation of national policies and clinical practice, representation of the profession to government and industry bodies, research within the discipline and setting competency standards within the profession. The assessment and accreditation of overseas podiatrists is conducted by the Australian and New Zealand Podiatry Accreditation Council (ANZPAC). Each state and territory also has its own association which represents the profession to community and other professional bodies, as well as acting as a contact point for the public. Contacts: Website: Psychology The Australian Psychological Society (APS) is the largest professional association for psychologists in Australia. It advocates that psychologists make a difference to peoples lives, through improving scientific knowledge and community wellbeing. The APS is dedicated to advancing the discipline and profession of psychology for the benefit of members and the communities they serve. Contacts: Website: Social Worker The Australian Association of Social Workers (AASW) is the national lead entity for professional Social Workers. It sets the benchmark for professional education and practice in addition to contributing to social work research and knowledge. The Association advocates on matters that impact upon the quality of life of all Australians including social inclusion, social justice and human rights. It has branches in all Australian states and territories. Contacts: Website: Speech Pathology Speech Pathology Australia (SPA) is the national peak body for the speech pathology profession in Australia, striving for excellence and recognition for the profession and representing the interests of members and their clients with communication and swallowing difficulties. One of SPA objective is to prescribe, guide and govern the clinical and ethical standards of members in their practice of speech pathology. Contacts:

48 National Allied Health Organisations AHPA Allied Health Professions Australia (AHPA) is the national voice of Allied Health in Australia. AHPA s vision is to be a powerful influence in Government health policy and decision making through comprehensive recognition as the peak body for national Allied Health associations. It aims to achieve this vision through effective representation of the Allied Health professions to deliver high quality, competent, informed advice consistent with the needs of the communities they serve. Contacts: IAHA Indigenous Allied Health Australia (IAHA) is the national peak body representing Aboriginal and Torres Strait Islander Allied Health professionals and students. It provides a strong voice and advocate for the Allied Health sector and build sustainable and positive relationships with professional associations, the notfor-profit sector and work in partnership with other Indigenous national Peak bodies. Contacts: SARRAH Services for Australian Rural and Remote Allied Health (SARRAH) primary objective is to advocate for, develop and provide services to enable Allied Health Professionals who live and work in rural and remote areas of Australia to confidently and competently carry out their professional duties in providing a variety of health services to rural and remote Australians. SARRAH has a national office in Deakin (ACT). Contacts:

49 Web Resources As discussed earlier in the chapter below is an indication on the availability of a search facility for professionals across Australia accessible from the Peak body website. AHPA Members Search function on website Audiological Society of Australia Yes (PDF service directory) Australian Association of Social Workers Yes* Australian Orthotic Prosthetic Association Yes Australian Diabetes Educator Association Yes Australasian Podiatry Council Yes Australian Osteopathic Association Yes Australian Music Therapy Association Inc Yes Dietitians Association of Australia Yes* Exercise Sport Science Australia Yes Occupational Therapy Australia Yes* Orthoptics Australia No (aiming for 2014) Speech Pathology Australia Yes The Chiropractors Association of Australia Yes The Australian Psychological Society Yes Other Professional Peak bodies Australian Physiotherapy Association Yes National Aboriginal and Torres Strait Islander Health Worker Association No Optometrists Association Australia Yes * Some restrictions exist including members can opt out of being searched or professionals may only be private practitioners. Table 3: Search facility on Peak body website for professionals 48

50 Allied Health Peak Body Services Below summarises the services each Peak body provides to their members and the community. The nature and scale of such services can vary significantly; therefore further information can be sought from the respective Peak bodies accordingly. Networking Services Profession Peak bodies Within the Allied Health profession Multidisciplinary events CPD Training Information for the public Professional Indemnity Insurance Research portal for journals & articles Advocacy Publications Aboriginal Health Worker Audiology Chiropractic Diabetes Educator Dietitics Exercise and Sport Science Music Therapy Occupational Therapy Optometry Orthotic/Prosthetic Orthoptics Osteopathy Physiotherapy Podiatry Psychology Speech Pathology Social Work Table 4: Allied Health Peak body services 49

51 6 Working Collaboratively to Achieve Integrated Care 50

52 Integrated Care Within the primary care setting there are many factors that influence the integration of care between General Practice and Allied Health professions. These include for example: structure of the care pathway ability to cross refer protocols, practice and culture types of information available and information exchange services and activities currently in place roles and responsibilities. In order to address many of the factors above, both GPs and Allied Health need to work collaboratively. MLs are well positioned to facilitate the development of better coordinate services and achieve greater service effectiveness and efficiency across the local primary health care system. Emphasis should therefore be placed on provider engagement across the full range of professions, building awareness and providing a clear focus on the promotion of an integrated system of care. Diagram 1 identifies the primary enabler for MLs engagement with Allied Health along with the supporting enablers to facilitate joint working and service integration. These are based upon feedback from Allied Health profession Peak bodies in the development of this guide. Stroke Rehabilitation Within the community setting GPs are in a pivotal position once a patient has been discharged from hospital. Examples of Allied Health professions who are often involved in team care arrangements include: occupational therapists who can provide advice, specialist equipment, including wheelchairs and recommending housing adaptations; social workers who are skilled in counselling; music therapists; to enhance recovery; dietitians for a healthy diet plan and speech and language therapists to support swallowing difficulties. Diagram 1: Key Enablers for Successful Allied Health Engagement and Integrated Care Education Collaboration Joint Vision Communication Engagement 51

53 Primary Enabler There are a variety of enablers to promote engagement with Allied Health professionals both individually and through their respective Peak body. Many Peak bodies indicate they welcome communication with MLs and support in disseminating information to their members. Below are descriptions of the key themes and suggestions for engagement with Allied Health at a local level obtained from Allied Health Peak bodies. Joint Vision General Practice and Allied Health can often be perceived to be working independently reflecting the local health economy rather than working collaboratively within a system of care. MLs can help address this by emphasising joint goals and developing joint strategies. Enablers include: Establishing locally agreed strategic priorities to enable all health professions to work towards the same goals and objectives Effective communication and strategic planning which could be supported through the establishment of an Allied Health forum Promotion of a shared commitment to a multi disciplinary approach in primary health care clarifying the role and contribution of Allied Health. All Allied Health professions (not just registered professions) to be eligible for representation on ML Boards, committees, clinical reference groups and working parties. 52

54 Supporting Enablers Education Communication GPs have a central role in the delivery of primary health care, being responsible for referrals, care management and treatment options. Having a better understanding of the capabilities and services offered by other practitioners and the evidence base to support and promote this is essential to timely and appropriate referrals. Enablers include: Correct understanding of each profession referral criteria and referral process Information on where the Allied Health services are and how they integrate with other services What being a self regulated or registered profession means Ensure GPs are kept up to date about Medicare Allied Health rebates. For example OTs can provide mental health services under the Medicare scheme MLs to assist all GPs to have a better understanding of the skills Allied Health professions have and services they can offer Support GPs to understand Allied Health work in a number of autonomous roles, so require recognition of the scope of their roles. Communication is often referred to as the ultimate key to collaboration but in order to achieve this the communication requirements need to be well understood. Good communication is essential to improve the quality and delivery of information and resources to all professions in community, eg newsletters, media releases, workshops and personal visits. Enablers include for example: Medicare Local events - to inform on the current ML strategies and discuss service developments (eg ehealth, secure messaging and other IT support) - to promote better local connections and identifying new opportunities where there are current health service delivery gaps. This will also help enable health priorities to be better addressed - bring Allied Health and GPs together to plan and co ordinate responses to challenges in the community, eg health promotion initiatives and self-management programmes Develop communication templates/protocols between ML, GP and Allied Health practices. These would help aid joint working and communication through the adoption of a standard approach Introduce better feedback mechanisms using surveys and focus groups to enable improved opportunities to be a part of setting strategic priorities. This would enable MLs to respond to any situation where Allied Health have less than optimal or adverse experiences to determine if structural difficulties or information gaps can be rectified for a more positive outcome Publish a section on the role of MLs for the Allied Health Peak bodies to promote on their website setting out how MLs are established, where they are and how Allied Health can get involved Promote Allied Health membership of the ML, noting that fees and charges are often a barrier for small scale practices Where there are multiple MLs in one area consolidate communication between MLs and the AML Alliance. Information can then be communicated through AML Alliance to each Peak body to provide a structured way of members getting up to date information. 53

55 Engagement Collaboration Community engagement may be defined as the process of 'working collaboratively with relevant partners who share common goals and interests. Engagement strategies include partnership building and networking, community mobilisation and community coalition building, all of which promote an integrated health care system. Enablers include: Actively source out the Allied Health professionals in the ML area to build a clear picture of services available Analysis and identification of service needs and gaps in the local area to identify both patient and Allied Health profession requirements Clarification of those Allied Health services and service models which provide the best outcomes for the local community needs Working alongside the Peak bodies identifying areas where it is more appropriate or efficient for Allied Health to provide services rather than a General Practice and then actively support migration of those services into the Allied Health area. Promote Interdisciplinary education opportunities This should be particularly around more generic issues such as medico-legal matters or around chronic disease management. Case study: Engagement model DoHA currently funds the Mental Health Professional s Network to develop online and local networks. It includes Webinars, GP podcasts, holds network meetings with coordinators across the Australia. This model is an example of good practice and an engagement model which could be leveraged for Allied Health professions generally. Further information: In the broader term collaboration is a good opportunity to widen networks, gain access to new skills and reach broader sections of the community, leading to ongoing relationships. Collaborative practice is achieved when there is an established and well maintained effective relationship with professions and together provides a high quality service which meets the community needs. Enablers include: Regular multidisciplinary team teaching sessions in the clinics for example, different themes from Allied Health professions as guest speakers so everyone understands roles and the programs offered MLs undertake a clinical review of care management to inform and promote development of joint working for the benefit of patient health outcomes, including for example confirming the number of occasions case reviews are held, professions involved and the reason for this MLs to support collaboration of GPs with Allied Health by introducing engagement with Allied Health as a KPI Conduct an Allied Health needs assessment that includes information on gaps, collaboration and educational needs. This would assist in understanding the needs of local Allied Health professionals practicing in the region and help inform an Allied Health engagement strategy including funding and program delivery Allied Health should be given opportunities, support and resources to participate as equal partners in primary care and hence improve communication behaviours Increase opportunities and access to network with fellow health practitioners in primary health including GPs and other Allied Health to share experiences. This may include working with SARRAH to improve webinars for rural and remote Allied Health Show case GP and Allied Health initiatives so the approaches can be shared, new collaboration and positive experiences grown Support expansion of co-location of services. Clinicians are more inclined to trust those they know and form effective teams accordingly Increase the number of programs and initiatives launched which focus on whole primary care framework Promote the development of a common language as the more common standards that are applied across medical, nursing and Allied Health the more likely there will be mutual respect for each other s scope of practice Effective credentialing is a critical component of clinical governance. MLs should work with Peak bodies to help raise awareness of the professional regulation and screening standards supporting alignment of the credentialing process for all employees and subcontractors While the benefits of engaging with professionals on the ground are essential and should be encouraged, the Allied Health peak bodies have structures to bring together collective views and should be the first point of contact for MLs. 54

56 Top 10 priorities for greater collaboration Following feedback from Allied Health Peak bodies and MLs in the development of this guide a number of building blocks for effective colloboration at a Primary healthcare level have been identified. These include: 1 All Allied Health profession to have support and access to e health and IT infrastructure and capabilities to be able to integrate more effectively with General Practice e.g. electronic referrals, secure messaging. 2 3 Encourage investment in Allied Health one stop centres as a way to avoid hospitalisation and re admissions and promote better lifestyles and cost effectiveness. Further develop video clips that explain individual Allied Health professions including roles, programs and the referral processes to fully promote the benefits provided MLs to focus on the development, funding and promotion of integrated multi disciplinary care projects mirroring existing programs like the Diabetes co ordination and assessment service (DCAS), Connecting Care Program and Wellness Centres. Increased events for multi disciplinary professionals and CPD opportunities for real learning and networking experiences covering not only roles but also current community issues including; obesity, vision, smoking, diabetes and hearing loss. Assistance with and submit applications for community grants which can be used to cover the costs of Allied Health staff and support workers to undertake projects and work in partnership to establish new services Establishment of an Allied Health advisory group within the ML to improve engagement, planning and recognition. This will provide valuable input into better engagement with GPs and a mechanism by which to develop innovative pathways. Build relationships with the individual Peak bodies, AHPA and NPHCP to establish trust and an open dialogue. This may include MLs having a regular slot on the professional Peak body magazines or e- newsletters. All Peak bodies should have a dedicated clear contact person in each ML, who can provide them with information about relevant Government programs and initiatives. Many Allied Health have reported not being aware of how they can be involved with their Medicare Local. Allied Health professionals to be on the ML boards (including both those from regulated and self regulated professions) to allow involvement in planning and strategic decision making. This will support collaboration and improve communication between professions. Pyramid of Priorities: 1 = Strategic Priority 2-3 = Key activities 4-6 = Core Tasks 7-10 = Foundations 55

57 Allied Health Support While General Practice has traditionally had the benefit of practice support services provided originally through Divisions of General Practice (DGP) and more recently MLs, Allied Health have received minimal support. In looking to work collaboratively with Allied Health, MLs may consider the following support needs when undertaking their strategic planning. Ordering has been based on the synthesis of feedback from Allied Health Peak bodies. IT Support E-health practice support and incentives to invest in compliant software to improve the common interoperable IT systems between GP and Allied Health. This would include advocating the use of secure messaging. Lobby to improve the inequalities for funding between GP and Allied Health (e.g. only GPs receive MBS items for case conferencing and teleconferencing). Program Support Education and support for those in programs involving communicating with those with intellectual disabilities. Hold a forum to report back to Allied Health on current activities and improvements in the local ML. Staff Development Support Promote awareness of Allied Health roles and programs they run to enable earlier referral and timely treatment for patients including the promotion of the correct referral processes for Medicare eligible services. Increased opportunities to have webinars for multidisciplinary team CPD events. Operational Support Improved cultural safety including support structures and coaching to prevent a high turnover of Allied Health professions who leave due to feelings of isolation and lack of support especially in rural and remote areas. Encourage GPs to share care plans with all disciplines involved in the patient s treatment. Allied Health professionals are required to provide feedback to the GP but not vice versa. Business Support Provide channeled support to business owners. Hold Allied Health business owners meetings to provide practice owners the opportunity to network ideas and investigate new innovations to benefit their practice and improve performance including maximising their income opportunities. Visit Allied Health professionals in their practices to see how they operate, and what programs they offer to promote the roll out of new initiatives linking services together. Financial Support Create adequate incentive systems aimed at encouraging collaboration. Adequate remuneration for both Allied Health and GPs are required to encourage true inter professional collaboration. Increase awareness of different grants available which would support the work of Allied Health and facilitate new programs to be introduced for the community, eg health and ageing grants. 56

58 7 Resources 57

59 Medicare Local Figure 1 below illustrates all MLs locations and boundaries taking into account alignment with Local Hospital Networks (LHNs), natural population catchment areas, configuration of health services and patient referral patterns between services. MLs contact details can be found by postcode location at: Alliance.com.au. Or to view a detailed map of Medicare boundaries by State please see: Figure 1: Medicare Local locals and boundaries 58

60 Disclaimer This publication has been prepared for general guidance and does not constitute professional advice. No representation or warranty (express or implied) is given as to the accuracy or completeness of the information contained in this publication, and, to the extent permitted by law, the Australian Medicare Local Alliance, its members, employees and agents do not accept or assume any liability, responsibility or duty of care for any consequences of you or anyone else acting, or refraining to act, in reliance on the information contained in this publication or for any decision based on it. 59

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