John Rasa, General Practice Victoria - Primary Care Workforce


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John Rasa, CEO, General Practice Victoria delivered this presentation at the 15th Annual Health Congress 2014. This event brings together thought leaders and leading practitioners from across the Australian health system to consider the challenges, implications and future directions for health reform.

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John Rasa, General Practice Victoria - Primary Care Workforce

  1. 1. Primary Care Workforce Adjunct Associate Professor John Rasa CEO Networking Health Victoria and CEO General Practice Victoria
  2. 2. Regional Integration • Integration of public and private services •Health Pathways • Integrating assessment & advice lines into health pathways • Developing advanced care planning systems • Patient-centred medical home trial • Better health care management in Aged Care Homes • Prevention, screening & early intervention Information & Technology • eHealth adoption • Establishing a coordinated telehealth system • Information provision in EDs about available after hours services • Community education regarding service options Infrastructure • Improved PHC infrastructure Skilled Workforce • Development of the primary health care workforce especially Allied Health Services •Support for placements of health care students in PHC PRIMARY HEALTH CARE REFORM FRAMEWORK
  3. 3. The Context of Primary Care Workforce Challenges  Australians are living longer due to scientific advances in medical care and public health policy  Growing proportion surviving with multiple chronic diseases  Study by Australian Primary Health Care Research Institute (2013) found that amongst 4574 respondents  82% had at least one chronic condition  52% had at least two chronic conditions  Average of 2.4 co-morbid conditions  Has implications for training & development of a disease management skill set of clinicians
  4. 4. Challenge of Chronic Illness in the Community Britt H., Miller G., & Henderson J., ‘Multimorbidity’ Australian Family Physician, Vol 42, 12, Dec 2013
  5. 5. The Context of Primary Care Workforce Challenges  Australia has a policy reform agenda to shift care from acute care towards the delivery of a connected primary health care system  There is a focus on prevention & better management of chronic disease.  Encourage health practitioners to work at the fullest extent of their scope of practice, encourage greater flexibility and multidisciplinary learning  Promoting the concept of medical home, patient centred models with strong consumer engagement
  6. 6. What we are doing to address the identified challenges? • Addressing the shortage of skilled health professionals • Current issues for regional and remote areas • Investing in nursing and allied health • Workplace training programs Examining the key work of Health Workforce Australia and the outcomes of the Mason Review of Australian Govt Health Workforce Programs Primary Care Workforce
  7. 7. Primary Care Workforce Work of HWA 2010-11
  8. 8. HWA Key Principles • Initiatives must build capability and explore roles based on a better balanced skill mix to meet community need rather than traditional professional demarcations. • A whole of workforce approach to reform should be used to ensure change is scalable, sustainable and replicable. • Reforms must span boundaries, geographical, jurisdictional, organisational and/or professional. Primary Care Workforce
  9. 9. Mason Review of Australian Govt Health Workforce Programs (April 2013) identified  Substantial growth in Commonwealth funding for health workforce programs from $286m in 2004-5 to $1.79b expected in 2016-17  HWA committed to $425m to support 1.7m additional clinical training placements for medicine, nursing & AHPs over 3 year period 2011-14  Support for rural medical training & expansion of vocational training programs (GP & specialist training)  Support for nursing/midwifery & dentistry, & to a lesser extent allied health. Primary Care Workforce
  10. 10. Mason Review of Australian Govt Health Workforce Programs (April 2013) identified  Identified the average working hours of many health professionals was in fact reducing  With the exception of nurses & midwives, the relative number of health professionals diminishes for communities located further away from major centres  The increasing prevalence of chronic disease has implications not only for number of health professionals but also the skill mix & models of care (ie. multi- disciplinary/team based care) Primary Care Workforce
  11. 11. Primary Care Workforce Medical Workforce in Australia (AIHW, 2012)  91,504 registered medical practitioners  79,653 (87%) were employed in medicine  Almost 2 out of 5 were women  1 in 4 were aged 55 or older  Work on average 42.7 hours per week  94.5% of all employed medical practitioners were working in a clinical role  3,035 domestic students commenced undergraduate training in Australia
  12. 12. Primary Care Workforce Medical Workforce in Australia (AIHW, 2012)  Average age of employed medical practitioners was 46.0 years with 37.9% being women  Age distribution is uneven with 51.8% women in 20-34 year age group but only 13.8% in the 75 and older age group  There were 221 (0.3%) Aboriginal or Torres Strait Islander employed medical practitioners reflecting a significant under-representation of Aboriginal people in the health workforce and there were14,022 Aboriginal health professionals overall (1.81% of all health professionals).
  13. 13. Primary Care Workforce Medical Workforce in Australia (AIHW, 2012)  Overall supply of clinicians (involved in diagnosis, care and treatment rose from 323.2 FTE per 100,000 population in 2008 to 355.6 FTE in 2012 (10% change)  But the supply of general practitioners only increased from 109.1 FTE per 100,000 population in 2008 to 111.8 FTE per 100,000 pop. in 2012 (2.5% change)
  14. 14. Employment settings of clinicians Primary Care Workforce 0 10 20 30 40 50 Hospitals Group Private Practice Solo Private Practice Community Health Care Education Other % Employed % Employed
  15. 15. Health Workforce 2025 (HWA, 2012) key findings were:  A sufficient number of medical specialists is projected but not in the communities that need them  There is a growing trend towards specialisation and sub-specialisation, which means Australia does not have enough generalists.  It is projected there will be a geographic maldistribution for general practitioners (GPs) and a number of other medical specialties, with a shortage in rural and remote communities and too many in metropolitan areas. Primary Care Workforce
  16. 16. Geographic maldistribution of general practitioners (GPs) raises a number of issues  Mason review recommends a modification of the ASGC- RA (remote areas) to a ‘modified Monash Model’ giving recognition to smaller communities (population <15,000) that are more vulnerable to workforce pressures discriminating between large and small towns in bands RA 2 & 3 while retaining the current RA 4 & 5 areas.  Mason review also recommends broadening the settings for the return of service obligation to include rural and remote areas in the Bonded Medical Places scheme, including Aboriginal Medical Services & defence force facilities. Primary Care Workforce
  17. 17. Health Workforce 2025 (HWA, 2012) key findings were:  The medical training pathway were poorly coordinated, which contributed to:  An uneven distribution of numbers between specialties.  Lost opportunities to address issues around geographic distribution and promote a better balance between generalist, specialist and sub-specialist training.  The Mason Review identified a lack of a clear pathway from undergraduate rural training into employment as a rural doctor. It identified the missing link as the lack of availability of rurally-based internership positions through which rurally trained medical students can transition directly to vocational GP training. Primary Care Workforce
  18. 18. Primary Care Workforce General Practice Workforce Statistics NATIONAL FIGURES 2012-13 2003-04 % Increase Head Count (a) 30,681 22,949 34% FTE 18,398 14,246 29% FWE 22,087 16,872 31% Total Services (b) ['000] 132,399 100,340 32%
  19. 19. Primary Care Workforce Major Cities Inner Regional Outer Regional Remote/ very remote TOTAL Population 2002 13,471,492 3,654,851 1,881,014 487,853 19,495,210 FWE – GP (2001-2002) 12,443 2,777 1,275 241 16,736 Ratio pop/FWE 1,083 1,316 1,475 2,024 1,165 Population 2012 15,976,750 4,161,150 2,047,432 525,020 22,710,352 FWE – GP (2011-2012) 15,109 4,014 1,677 319 21,119 Ratio pop/FWE 1,057 1,037 1,221 1,646 1,075 % Change pop/FWE 2% 21% 17% 19% 8%
  20. 20. Medical Workforce definitional issues with Primary Care Supply Data  RWA data looks at FWE-equivalents, which is based on Medicare billing data and doesn’t count non-Medicare billable work undertaken by GPs  AIHW FTE data is based on medical practitioners/GPs working 40 hours per week (in line with National Healthcare Agreement)  ABS distinction of full-time and part-time based on a standard 35 hour week Primary Care Workforce
  21. 21. Key trends and small wins (Rural Health Workforce Australia (Nov 2012)  7378 GPs working in rural and remote Australia (6.1% increase)  The proportion of female practitioners working in ASGC-RA 2 to ASGC-RA 5 locations has also increased by 1 percent to 37.8%, from the previous year.  There are increasing numbers of female practitioners in younger age groups.  Average age for male GPs was 51.7 years and 46.7 years for females, with the average age for all practitioners was 49.9 years.  Proportion of female GPs working full-time increased from 40.5% in 2011 to 45.8% in 2012. Primary Care Workforce
  22. 22. Key trends (Rural Health Workforce Australia (Nov 2012) • A small increase in the average number of GP clinical hours worked per week from 34.3 hours in 2011 to 35 hours in 2012 which is consistent with the average observed in 2010 (35.1 hours). • The average length of stay in practitioners’ current practice has reduced slightly from 8 years in 2010 to 7.6 years in 2012. • Whilst there has been an increase in the number of GP proceduralists, the proportion of practitioners providing procedural services in 2012 (12.6%) is relatively steady compared to the year before (12.2%). Primary Care Workforce
  23. 23. Primary Care Workforce -Nurses Nurses can play a significant role in primary health care to manage people with chronic and complex conditions  Nurses can provide care equivalent to doctors within their scope of practice but have longer consultations.  Lifestyle interventions provided by nurses have been shown to be effective for cardiac care, diabetes care, smoking cessation and obesity. Parkinson, A.M. and Parker , R. Addressing chronic and complex conditions: what evidence is there regarding the role primary healthcare nurses can play? Australian Health Review, 2013, 37, 588–593
  24. 24. Primary Care Workforce -Nurses  Mason review found that with the introduction of degree level study for nurses/midwives, for nurses who have been out of the workforce for more than 10 years, it acts as a disincentive to return to the workforce – particularly impacting rural settings and Aboriginal communities.  The Mason Review suggested support for re-entry programs for this group  Commonwealth has increased investment in practice nursing and scholarships totalling 34% of the funding under the Health Workforce Fund in 2011-12  Actions suggested increasing opportunities for enrolled nurses, nurse practitioners & personal care workforce
  25. 25. HWA Initiatives  Initiatives including National Medical Training Advisory Network  Developing a nationally consistent approaches to funding clinical training placements in the public, non- government & private sectors.  $425m investment in Clinical Training Fund to increase the number of clinical placements across all parts of Australia. The number of clinical placement days increased by 50% in 2012 compared to 2010. Primary Care Workforce
  26. 26. HWA Initiatives  $85m investment in the Simulated Learning Environments to support simulation equipment/capital ($44.4m)& recurrent investment ($30.2m)in simulated training delivery. Delivered a 115% increase in simulation education hours in 2012 compared to 2010. Primary Care Workforce
  27. 27. HWA Initiatives  Integrated Regional Clinical Training Network was provided $32m over three years to support IRCTNs  Case Study of Inner East Melbourne Medicare Local which accessed Innovative Clinical Teaching and Training Grants for GPs & other health professionals in expanded learning environment to support 250 placements over three years utilising <$100k grants. Melbourne University provided field support. Primary Care Workforce
  28. 28. 28 IEMML Strategic Actions :  Clinical Education Alliance with Deakin, Melbourne & Monash Unis, VMA, RACGP, GP practices & others.  Expand local practices capacities to host learners.  Support education providers re local practice based clinical placements.  Advocate for clinical training resources.  IEMML’s role to assist but not replace effective engagement between educators & practices.
  29. 29. 29 Clinical Education Alliance outcomes to date include:  ICTTG (DoH) infrastructure funds for practices.  HWA / Vic Gov clinical placements Expanded Settings funds.  Major baseline increases in nursing and medical student placement capacities.  Clinical supervisor training for in- practice teachers (TOTR).  Clinical training support web portal for practices.
  30. 30. 30 Initial Clinical Training Support Partners: 1 discipline medicine; with 1 service type GPs (total 186 practices); with 4 education providers & 1 professional college. Future Clinical Training Support Partners: 15 + health disciplines; with many different PHC service types (total 1950 service entities); with multiple education providers/ professional associations.
  31. 31. Final Observations  Additional GPs still required for rural and remote areas so funding formulas need further refinement to incentivise  Maximise the workforce participation of existing GPs  New models of care with greater use of up-skilled nurses and AHPs & greater collaboration in clinical placements  Capitalise on innovations in telehealth, online learning, and facilitate the development of health professional networks Primary Care Workforce
  32. 32. Primary Care Workforce Thank You Adjunct Associate Professor John Rasa CEO Networking Health Victoria