Advanced and Extended Scope of Practice for Physiotherapists
Q. Will your party continue its commitment to develop physiotherapy advanced and extended scope of practice roles and look to expand physiotherapy involvement in orthopaedic, neurosurgery and rheumatology triage and screening clinics and emergency departments, and elective joint replacement programs?
There are already a number of advanced practice and/or extended scope roles being provided by physiotherapists in the public hospital system across Australia, and there remains much potential for increasing and developing these further.
Existing roles for physiotherapists in Emergency Departments, spinal assessment, orthopaedic and post-arthroplasty clinics. In these roles, physiotherapists have demonstrated they are competent, cost effective and improve patient access, care and outcomes.
Future tasks could potentially involve prescription of pharmaceuticals, injection procedures and direct referral to medical specialists. These advancements have been seen to be extremely beneficial to the effective patient journey across the world.
Endorsement for Physiotherapy Prescribing
Q. Does your party support the introduction of prescribing rights for appropriately trained and endorsed physiotherapists within their scope of practice?
In 2013, Health Workforce Australia (HWA) released an excellent piece of work called the Health Professionals Prescribing Pathway (HPPP), enable the development of protocols that allow physiotherapists and health professions other than medical doctors to follow a rigorous and competency-based program to prescribe medications.
The APA strongly supports the HPPP, which has been endorsed by the Australian Health Ministers' Advisory Council (AHMAC). The APA is advocating to enable registered members of the profession to have the capacity to prescribe medications considered necessary for effective treatment of patients.
Physiotherapists in NSW with autonomous prescribing rights would work within the existing framework of medicines and prescribing legislation, governance and professional codes of practice. Physiotherapists would be required to meet requirements through rigorous training and continued education, as proposed by the HPPP. Within this framework, patient safety would be enhanced because physiotherapists would be professionally accountable and responsible for assessment, diagnosis and prescribing including actions and omissions and could not delegate this accountability to any other person. The quality of patient care in NSW would improve by avoiding delays in patient care and by improving the specificity and responsiveness of prescribing.
If implemented, autonomous prescribing for NSW physiotherapists would present a significant opportunity to effect system-wide change that would provide value for money and the greatest benefit to consumers, as well as improve access and choice and reduce health inequalities.
More information on physiotherapy prescribing rights is available at www.physiotherapy.asn.au\prescribing.
Greater Support for Physiotherapy in Rural and Remote NSW
Q. Will your party provide greater support to facilitate patient access to physiotherapy in rural and remote NSW?
Following the release of new data by the Australian Bureau of Statistics (ABS) highlighting greater healthcare barriers for regional and remote Australians compared to people living in major cities, the APA is calling for greater access to physiotherapy in these regions. Advancing physiotherapy opportunities to ensure better care for patients in rural and regional areas comes through increasing funding and resourcing, providing greater career opportunities, enhancing technology and reducing legislative barriers.
One key legislative change the APA is campaigning for is enabling physiotherapists to refer patients direct to medical specialists, with the provision that physiotherapy patients would receive a Medicare rebate. This is of particular concern in rural or remote areas of the state where, according to recent ABS data, nearly one in three people living in outer regional, remote or very remote areas waited longer than they felt acceptable to get an appointment with a GP compared with just over one in five in major cities. Enabling physiotherapists to refer direct to medical specialists would significantly improve patient care in remote and regional areas and benefit the economy and healthcare system through cost-savings by avoiding circular referral.
Public Health Sector Services and Conditions
Q. Will your party support in principle the implementation of policies which mandate timely action for dealing with public health physiotherapy vacancies?
Physiotherapists within the public sector are concerned that there are no internal policies currently in place that enable allied health departments or services to obtain authorisation for the recruitment against long-term vacancies.
This issue was highlighted in recommendations contained in the 2008 Special Commission of Inquiry, Acute Care Services in Public Hospitals report by Peter Garling. Specifically that “the institution of policies which mandate timely action for dealing with vacancies of allied health professionals so as to ensure that replacements occur when Allied Health staff are on annual leave, maternity leave or long service leave”.
It is acknowledged that it may not be feasible to fund backfill for all instances of planned leave (e.g. Annual Leave and Paid Maternity Leave) but in the case of permanent vacancies that form part of funded staffing establishments, unfilled vacancies and staff shortages have an impact of suboptimal patient care, longer inpatient stays, increased cost of care, and poorer patient outcomes.
Recent changes and restructures in NSW health were implemented to increase the potential for local management decision making and control in regards to service delivery and budgets. Local managers are involved in building budgets based on service needs, staffing establishment and managing their actual expenditure. The current inability to obtain approval to recruit to vacant positions that are part of this staff establishment is in direct contradiction to the goals of this increased responsibility.
Q. Will your party support in principle the implementation of clear professional physiotherapy leadership roles in all Local Health Districts/Specialty Health Networks?
The structure of physiotherapy services across NSW Local Health Districts is inconsistent. While in some districts there is an identifiable service director or clinical lead for physiotherapy, in others an equivalent position is non-existent. In such instances physiotherapy managers/department heads are required to report directly to a site allied health manager and/or an allied health district director. In either case the discipline of physiotherapy and hence matters related to physiotherapy service delivery and practice are not represented or governed at the district level.
The implications of this include (but are not restricted to):
- Inefficiencies and inequalities in staffing and resource distribution across sites/facilities and services.
- Ineffective service planning and development and lack of participation in coordinated clinical practice improvement and clinical redesign.
- Ineffective distribution of resources to meet the complexities of patient and service needs across the district.
- Inconsistencies in representation and consultation on behalf of physiotherapy at district level.
- Inability to effectively deal with discipline specific issues and enquiries such as investigations, complaint management, scope of practice and personal/positional regrading applications