Policy Paper: Accessible allied health primary care services for all Australians

Policy Paper: Accessible allied health primary care services for all Australians March 2013

Contents Contents... 2 AHPA s call to action... 3 Position Statement... 4 Background... 6 Healthier Australians through accessible allied health services... 8 Utilising allied health professionals to enhance efficiency and outcomes... 8 The expanding role of allied health professionals in primary care service delivery... 9 Improving access to allied health professionals enhances consumer outcomes... 11 Innovative funding models to ensure equity of access... 12 Coordinated primary care within and beyond the broader health sector... 13 Appendix 1 Definition of allied health... 14 About Allied Health Professions Australia... 15 Visit: http://www.ahpa.com.au/home/alliedhealthrepresentation/ahpapositionstatements.aspx to view 2013 Allied Health Professions Australia Version 1:03/13 2 AHPA s 2013 Federal Election Platform, Policy Papers and Position Statements.

AHPA s call to action AHPA seeks recognition of the allied health professions as key stakeholders in primary care. The current diversity of primary care service provision is generally not adequately acknowledged. Working collaboratively to enhance primary care governance and delivery through better engagement of allied health professionals in primary care, particularly at the local level, would lead to enhanced outcomes for consumers. AHPA is pursuing opportunities to work collaboratively with governments to implement reforms that improve consumer outcomes and encourage a consumer-led model of care by enhancing access to the services provided by allied health professionals. These services demonstrate a cost-effective use of resources, often significantly reducing the consumers need for further treatment including hospitalisation, providing efficiencies in the utilisation of resources resulting in cost savings. AHPA strongly supports the introduction of measures to improve equity of access to primary care services and seeks an undertaking from the Australian Government for reforms that address these issues. AHPA seeks reform that provides appropriate access to best practice multidisciplinary primary care, builds on the current MBS packages to achieve evidence-based funding models, enables sustainable, consumer-led alternatives to the gatekeeper role presently designated to GPs, and introduces referral rights for health practitioners that are commensurate with their skills, knowledge and abilities. AHPA seeks to work with the government to develop flexible and equitable funding models that better reflect the value of services provided, support consumer needs, improve access and outcomes, and promote an evolving health sector by supporting research, innovation and improving the health literacy of consumers and other stakeholders, particularly in respect to allied health. 2013 Allied Health Professions Australia Version 1:03/13 3

Position Statement Accessible allied health primary care services for all Australians The majority of allied health professionals provide primary care services. Introducing reforms that enhance access to the services provided by allied health professionals will improve consumer outcomes and encourage a consumer-led model of care. Importantly, reform in primary care service delivery can also significantly reduce the need for further treatment including hospitalisation, providing efficiencies in the utilisation of resources resulting in cost savings. Consumers much prefer to stay in their community rather than having to go to hospital. The continuing evolution of allied health professions as key providers across all settings, including primary care over recent decades, presents a significant and largely untapped opportunity to introduce more evidence-based, effective and efficient service delivery models. At around 18% of the total health workforce, allied health professionals now represent a similar proportion to doctors. Allied health professionals provide over 200 million services annually 1, improving the quality and/or life expectancy of consumers and providing the primary treatment modalities in a number of conditions. It is evident that an understanding of the breadth of allied health is essential to optimising the role of allied health professionals in primary care and ensuring the community reaps the full benefits of our highly trained and engaged workforce. Recent efforts to redesign primary care governance structures at the local level through the introduction of Medicare Locals, as well as address community-specific shortages through the establishment of GP Super Clinics, are acknowledged. However, AHPA reiterates its disappointment that these initiatives often do not adequately represent the current diversity of primary care service provision. Allied health professionals are and must continue to be part of both the current and future of primary care service delivery. AHPA seeks endorsement of the allied health professions as key stakeholders in primary care, and the opportunity to work collaboratively to 2013 Allied Health Professions Australia Version 1:03/13 4 1 Allied Health Professions Australia, Policy Paper Allied health professionals: Making an impact on the health of all Australians, March 2013. Available at: www.ahpa.com.au

enhance primary care governance and delivery through better engagement of allied health professionals in primary care at the local level. Although evidence demonstrates that access to the right practitioner, in the right place at the right time enhances consumer outcomes and is an effective use of resources, geographic isolation and social disadvantage currently limit and/or exclude consumers from accessing primary care services provided by allied health professionals. AHPA strongly supports the introduction of measures to improve equity of access to services and seeks an undertaking from the Australian Government for reforms in primary care that tackle the major access and equity issues that affect people now. 2 In particular, AHPA seeks reform that provides appropriate access to best practice multidisciplinary primary care; builds on the current MBS packages to achieve evidence-based funding models; effectively uses technological solutions; enables sustainable, consumer-led alternatives to the gatekeeper role presently designated to GPs; and introduces referral rights for health practitioners that are commensurate with their skills, knowledge and abilities. AHPA notes that current Australian Government funding made available for services provided by allied health professionals is based on budget constraints rather than providing access to evidence-based services that improve consumer outcomes. We seek to work with the government to develop flexible and equitable models that better reflect the value of services provided, support consumer needs, improve access and outcomes, and promote an agile and self-improving system 3 by supporting research and innovation. Funding should also enable initiatives that improve the health literacy of consumers and other stakeholders, particularly in the emerging allied health area, empowering them to make informed decisions in a consumer-led model of care. 2013 Allied Health Professions Australia Version 1:03/13 5 2 A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission June 2009, p. 7. Available at: http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1afdeaf1fb76a1d8ca257600000b5be2/$file/final_report_of_the%20nhhr c_june_2009.pdf, accessed 26/2/13. 3 ibid.

Background The World Health Organization (WHO) defines primary health care as given by the first contact provider along with promotional, preventive and rehabilitative services provided by multi-disciplinary teams of health-care professionals working collaboratively outlining the ultimate goal is better health for all. 4 Five key elements are identified: reducing exclusion and social disparities in health organising health services around people s needs and expectations integrating health into all sectors pursuing collaborative models of policy dialogue increasing stakeholder participation. 5 The Australian Government builds on this, stating that Primary care is the part of Australia s health system that people use most. It is the first primary point of health care delivered in and to people living in their communities outside of hospitals. 6 In 2012 the Australian Institute of Health and Welfare reported that the majority of health care services are provided through the primary care system, including services subsidised by the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Schedule, as well as over one-third of hospital emergency department presentations which were deemed GP-type consultations. However, as there is no nationally coordinated approach to data collection, fundamental questions relating to access and outcomes remain unanswered. 7 It also noted that service delivery, funding and governance arrangements for primary health care continue to be complex and the complex, fragmented and often uncoordinated service delivery system has implications for the services people receive and how they are paid. 8 Australia continues to embark on a wide-ranging health reform agenda. As the area in which both demand and the potential to positively influence outcomes is highest, it is essential that primary care 2013 Allied Health Professions Australia Version 1:03/13 6 4 From: http://www.who.int/topics/primary_health_care/en/ 5 ibid. 6 From: http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/theme-primarycare 7 Australian Institute of Health and Welfare 2012. Australia s health 2012. Australia s health series no. 13. Cat. no. AUS 156. Canberra: AIHW, p. 374. 8 ibid.

service delivery and governance are optimised. Whilst much has been achieved over recent years, fragmented systems and lack of data make it difficult if not impossible to evaluate outcomes and plan for innovative, efficient, primary health care delivery. Throughout any reform process it is important to reflect on the goals. For Australia s health system, and primary care, these are perhaps best reflected in the key statements made by the National Health and Hospital Reform Commission (NHHRC) in its report A Healthier Future for all Australians. Published in June 2009, it recommended adoption of the vision A sustainable, high quality, responsive health system for all Australians, now and into the future, and identified three reform goals: Tackle the major access and equity issues that affect people now. Redesign our health system to meet emerging challenges. Create an agile and self-improving health system for future generations. 9 AHPA believes this will only be achievable when Australian health consumers receive equitable access to allied health services. 2013 Allied Health Professions Australia Version 1:03/13 7 9 A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission June 2009, p. 13. Available at: http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1afdeaf1fb76a1d8ca257600000b5be2/$file/final_report_of_the%20nhhr c_june_2009.pdf, accessed 26/2/13.

Healthier Australians through accessible allied health services It is widely documented that changes in the health needs of the Australian population including population growth, ageing, the management of chronic disease and mental health, and increased health literacy and expectations will continue to place increasing pressure on the sector to deliver high quality, safe and accessible services in a timely and cost-effective manner. The continuing evolution of allied health professions as key providers in primary health care across the entire range of settings over recent decades presents a significant, and largely untapped opportunity to introduce more evidence-based, effective and efficient service delivery models. Introducing innovative reforms in primary care that enhance access to the services provided by allied health professionals will improve consumer outcomes through early intervention, better preventive health care and streamlined service delivery, and encourage a consumer-led model of care. Importantly, equitable access and reform in primary care service delivery can also significantly reduce the need for further treatment including hospitalisation, providing efficiencies in the utilisation of resources and cost savings. The opportunity to better utilise allied health professionals across all areas of primary care is essential to building a sustainable, high quality and responsive health system. 10 It is evident, however, that stakeholders do not yet have sufficient understanding of allied health and its potential. Recognition and support of allied health by government and other stakeholders will promote better utilisation and effective best practice models of care, ensuring consumers, and the community as a whole, are able to reap the full benefits of our highly trained and engaged workforce of allied health professionals. Utilising allied health professionals to enhance efficiency and outcomes The WHO identified key elements in improving primary care as increasing stakeholder participation and pursuing collaborative models of policy dialogue. 11 Similarly, the NHHRC report recommended 2013 Allied Health Professions Australia Version 1:03/13 8 10 A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission June 2009, p. 13. Available at: http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1afdeaf1fb76a1d8ca257600000b5be2/$file/final_report_of_the%20nhhr c_june_2009.pdf, accessed 26/2/13. 11 From: http://www.who.int/topics/primary_health_care/en/

redesign(ing) our health system to meet emerging challenges. 12 In primary care, there are numerous Australian Government initiatives seeking to improve the access to and quality of primary care services. In recent years a nation-wide network of Medicare Locals was established to coordinate primary health care delivery and tackle local health care needs and service gaps drive improvements in primary health care and ensure that services are better tailored to meet the needs of local communities 13 Regions identified as having limited access to primary care services have also been targeted by tailored initiatives, including the introduction of 60 GP Super Clinics. While these efforts indicate some progress, AHPA reiterates its disappointment that in most instances these initiatives neither acknowledge nor represent the current diversity of primary care service provision. By introducing new structures based on old ways of delivering health services, including the use of medicine-centric terminology, the Australian Government has risked stifling reform and overlooking evidence-informed innovation. The government also risks missing opportunities to better contain health costs. The cost of providing allied health interventions is often seen as an extra cost rather than a better use of existing funds to allow the most appropriately qualified practitioner to provide the service. Allied health professionals are a significant provider of current and future primary care service delivery. As an important and growing stakeholder, allied health professionals must be supported and encouraged to engage in all areas, from representation on the Boards of Medicare Locals to enhance governance diversity, through to the design, implementation and review of health service delivery to meet the needs of local consumers. AHPA wishes to work with the Australian Government to enhance primary care through better engagement and support of allied health professionals in local communities. The expanding role of allied health professionals in primary care service delivery Allied health professions 14 have evolved rapidly over recent decades in response to the growing need for a health workforce in both preventive and primary health care, increasing their capability to deliver 2013 Allied Health Professions Australia Version 1:03/13 9 12 A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission June 2009, p. 7. Available at: http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1afdeaf1fb76a1d8ca257600000b5be2/$file/final_report_of_the%20nhhr c_june_2009.pdf, accessed 26/2/13. 13 From: http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/medilocals-lp-1 14 Allied Health Professions Australia, Definition of Allied Health, 2012. Available at: http://www.ahpa.com.au/home/aboutalliedhealth.aspx, accessed 6/3/13. See also Appendix 1.

both generalist and specialised health services. Through their respective professional associations, the professions have sought to ensure the knowledge, skills and abilities of their professionals enables them to deliver safe, high quality health services, either autonomously or through multidisciplinary care teams. The allied health workforce in Australia is comprised of allied health professionals and technicians, assistants and support workers who work with allied health professionals. 15 Allied health professionals are usually required to practise autonomously, providing direct consumer care, including diagnosis, treatment and rehabilitation. There is strong evidence to demonstrate the effectiveness of evidencebased services provided by allied health professionals. Access to the right practitioner in the right place at the right time enhances the consumers health outcomes, reducing their need for more expensive treatments and assisting them to contribute both socially and economically to the community. As the overall body of health knowledge has grown, and greater consumer health literacy has increased expectations, allied health professions have evolved to meet demand. At around 18% of the total health workforce, allied health professionals now represent a similar proportion to doctors, with a smaller percentage aged over 55, and more rapid overall growth. 16 Annually, allied health professionals provide over 200 million services 17 that improve the quality and/or life expectancy of consumers. The majority of allied health professionals provide primary care services. There are, however, only a very limited number of MBS packages, which are generally poorly designed, as well as some services available through the community sector. The majority of primary care services provided by allied health professionals are paid for in full by the consumer, or they attract a significant gap payment or are funded through private health insurance. As well as utilising the skills of allied health professionals to deliver evidence-based primary care services, their broad knowledge is particularly suited to roles in assessing the needs of consumers, the provision of training and leadership of support staff, contributing to the development of effective multidisciplinary models of care, quality assurance and management. In 2011 the Productivity Commission acknowledged the skills of allied health professionals by recommending they be utilised as 2013 Allied Health Professions Australia Version 1:03/13 10 15 Allied Health Professions Australia, Definition of Allied Health, 2012. Available at: http://www.ahpa.com.au/home/aboutalliedhealth.aspx, accessed 6/3/13. See also Appendix 1. 16 Australian Institute of Health and Welfare 2012. Australia s health 2012. Australia s health series no. 13. Cat. no. AUS 156. Canberra: AIHW, p. 494. 17 Allied Health Professions Australia, Policy Paper Allied health professionals: Making an impact on the health of all Australians, March 2013. Available at: www.ahpa.com.au

assessors, determining the needs of consumers covered under the proposed National Disability Insurance Scheme. 18 AHPA concurs with the NHHRC that Australia needs engaged and empowered consumers to assist in creating an agile and self-improving health system. 19 The relatively recent emergence of the provision of autonomous allied health services in primary care does, however, present some immediate challenges as consumers, referrers and other stakeholders are not always aware of the range of health services delivered by allied health professionals and the outcomes that can be achieved. Initiatives to educate health care providers and empower consumers to make decisions in relation to primary care must include strategies to support informed choice through improved health literacy, particularly in relation to allied health. Improving access to allied health professionals enhances consumer outcomes The WHO states that reducing exclusion and social disparities in health, organizing health services around people s needs and expectations contributes to better health for all. 20 This is particularly relevant in the growing allied health sector, where geographic isolation and social disadvantage currently limit and/or exclude consumers from accessing services. These limitations are contrary to evidence that demonstrates that access to the right practitioner, in the right place at the right time enhances consumer outcomes and is an effective use of resources, reducing the need for further treatment, including hospitalisation. AHPA strongly supports any measures to improve equity of access to services provided by allied health professionals where evidence demonstrates improved consumer outcomes as well as efficient use of resources. AHPA seeks an undertaking from the Australian Government for reforms in primary care that tackle the major access and equity issues that affect people now. 21 Historical systems that are no longer relevant or evidence-based, and that impinge on both sustainability and access, must be set aside. For reform 18 Productivity Commission 2011, Disability Care and Support, Report no. 54, Canberra, p. 305. Available at: http://www.pc.gov.au/projects/inquiry/disability-support/report, accessed 21/2/13. 19 A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission June 2009, p. 7. Available at:http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1afdeaf1fb76a1d8ca257600000b5be2/$file/final_report_of_the%20n hhrc_june_2009.pdf, accessed 26/2/13. 20 From: http://www.who.int/topics/primary_health_care/en/ 21 A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission June 2009, p. 7. Available at:http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1afdeaf1fb76a1d8ca257600000b5be2/$file/final_report_of_the%20n hhrc_june_2009.pdf, accessed 26/2/13. 2013 Allied Health Professions Australia Version 1:03/13 11

to lead to improvement in the health of Australians, it must provide appropriate access to best practice multidisciplinary primary care, build on the limited MBS packages with evidence-based funding models, enable sustainable and flexible alternatives to the gatekeeper role presently designated to GPs, and introduce referral rights for health practitioners that are commensurate with their skills, knowledge and abilities. AHPA seeks endorsement of the allied health professions as a key stakeholder in primary care, including service delivery. Collaboration across the sector is required to Redesign our health system to meet emerging challenges 22 through enhanced consumer access to allied health primary care services that are consistent with best practice and evidence-based outcomes. Innovative funding models to ensure equity of access In principle, AHPA supports funding models that facilitate equitable access to evidence-based health services delivered by appropriately trained and regulated health professionals. The services must be able to demonstrate enhanced consumer outcomes and efficient use of resources, as well as encourage a consumer-led model of care. Funding must recognise the skills and abilities of the provider and be determined equitably. It should incorporate some flexibility to acknowledge external factors which increase the complexity or cost of delivering some services, restricting access for socially or geographically disadvantaged consumers. Importantly, funding must ensure sustainable and efficient health service delivery and promote an agile and self-improving system 23 by supporting research and innovation. AHPA contends that current Australian Government funding made available for primary care services provided by allied health professionals is based on budget constraints rather than equity of access or improved consumer outcomes. We seek to work with the government to develop models that better reflect the value of services provided, support consumer needs and improve outcomes. 2013 Allied Health Professions Australia Version 1:03/13 12 22 ibid. 23 A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission June 2009, p. 7. Available at: http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1afdeaf1fb76a1d8ca257600000b5be2/$file/final_report_of_the%20nhhr c_june_2009.pdf, accessed 26/2/13.

Coordinated primary care within and beyond the broader health sector The complexity and fragmentation of the current health system is difficult for consumers to navigate and creates unnecessary barriers. Their journey can be fraught not only with red tape, but often with confusion around access and funding. Within primary care, enhanced multidisciplinary teamwork will help to ensure that consumers receive a high level of coordinated care tailored to their needs. Adoption of innovations, such as e-health and funded tele-consultations, should facilitate better access and coordination, contributing to an outcome-focused, consumer-led model of care. Access to such innovation should be equitably distributed to all primary care practitioners and the consumers who use them. AHPA supports a broader vision of integrated health and care that eliminates the current disconnect and cost shifting between sectors within health and promotes communication to appropriate areas outside health, including welfare and housing. 2013 Allied Health Professions Australia Version 1:03/13 13

Appendix 1 Definition of allied health The allied health workforce in Australia is comprised of allied health professionals and technicians, assistants and support workers who work with allied health professionals. In this definition, Allied Health Professions Australia (AHPA) aims only to define the allied health professions and their professionals. Background In both the international and national domain there is no universally accepted definition of allied health professions. Instead, a range of definitions are used in various sectors. A variety of professions are listed as allied health professions by various government authorities and departments, health service providers, health funds and tertiary institutions. It is well accepted that the allied health subset of the Australian health professions does not include medical, nursing or dental professionals. Professions Australia has defined a profession as: a disciplined group of individuals who adhere to ethical standards and who hold themselves out as, and are accepted by the public as possessing special knowledge and skills in a widely recognised body of learning derived from research, education and training at a high level, and who are prepared to apply this knowledge and exercise these skills in the interest of others. It is inherent in the definition of a profession that a code of ethics governs the activities of each profession. Such codes require behaviour and practice beyond the personal moral obligations of an individual. They define and demand high standards of behaviour in respect to the services provided to the public and in dealing with professional colleagues. Further, these codes are enforced by the profession and are acknowledged and accepted by the community. AHPA s Definition of Allied Health Professions AHPA uses and builds on Professions Australia s definition of a profession with additional specifications: An allied health profession is one which has: a direct health consumer 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. 2013 Allied Health Professions Australia Version 1:03/13 14

About Allied Health Professions Australia Allied Health Professions Australia (AHPA) is the national peak body for the allied health professions in Australia, with 18 national associations as member organisations. Collectively, these organisations with their members in public, private, not-for-profit, rural and regional services across Australia work together to provide an effective voice for over 57,000 allied health professionals. As the largest peak body representing and advocating for the role of allied health professions in Australia, AHPA provides unified advice to government and key stakeholders across a broad range of issues, seeking to improve the health and wellbeing of all Australians. Australia has a well-developed workforce of allied health professionals who utilise their specialised knowledge and skills to improve consumer outcomes. Allied health professionals work autonomously, as part of multidisciplinary teams and are available to supervise other health workers, including assistants and technicians. AHPA and its member organisations consider the role of appropriately trained and regulated allied health professionals is vital to the delivery of safe and effective health services, and ensuring the community has access to the right practitioner in the right place at the right time. Please direct enquiries to: Lin Oke Executive Officer Allied Health Professions Australia PO Box 38, Flinders Lane VIC 8009 P: +61 3 8662 6620 F: +61 3 9663 6177 M: 0414 473 482 E: office@ahpa.com.au W: www.ahpa.com.au 2013 Allied Health Professions Australia Version 1:03/13 15

Member organisations: Audiological Society of Australia Australasian Podiatry Council Australian and New Zealand College of Perfusionists Australian Association of Social Workers Australian Music Therapy Association Australian Orthotic Prosthetic Association Australian Osteopathic Association The Australian Psychological Society Australian Sonographers Association Chiropractors Association of Australia Dietitians Association of Australia Exercise & Sports Science Australia Occupational Therapy Australia Orthoptics Australia Society of Hospital Pharmacists of Australia Speech Pathology Australia Associate members: Australian Diabetes Educators Association 2013 Allied Health Professions Australia Version 1:03/13 16 Australian Association of Practice Managers Allied Health Professions Australia PO Box 38, Flinders Lane VIC 8009 P: +61 3 8662 6620 F: +61 3 9663 6177 E: office@ahpa.com.au W: www.ahpa.com.au