At the end of October, the ACA welcomed the release of the final report on the Scope of Practice Review, ‘Unleashing the Potential of our Health Workforce’. Sent to Health Ministers on 30 October, the recommendations in this report, if adopted, represent perhaps the most significant reform of the Australian Healthcare system since the introduction of Medicare in 1984.
Key reforms proposed in the report will ensure each professions’ value is recognised, with safeguards for a safe, high-quality health system, delivering best value care to ensure the needs of the community are met, including accessibility for all Australians. For the chiropractic profession, the recommendations represent opportunity for increased collaboration and participation in the healthcare system.
What is the Scope of Practice Review
The Scope of Practice Review is a comprehensive analysis of the roles, responsibilities, and legal boundaries of healthcare professionals. It aims to evaluate whether current regulatory, pricing, and healthcare delivery frameworks are aligned with modern practices, patient demands, and the need for interdisciplinary collaboration.
A detailed outline of the review and its key themes and activity was reported on in the June 2024 edition of The Australian Chiropractor magazine. The June article provides a good overview to understand the final recommendations discussed in this report.
How has the ACA participated and advocated for the Profession?
The review and its associated consultations, workshops and research were extensive and informed by thousands of submissions from a wide range of health and consumer stakeholders. The ACA has participated robustly at every opportunity and in all stages of the consultation including attendance at multiple workshops and roundtables, spanning peak body, individual practitioner and National Rural Health Alliance (NRHA) members workshops. We have advocated within all collaborative spaces available to us, highlighting:
- The under-utilisation of the full skill and competency of the chiropractic profession.
The barriers experienced by the profession to participate both in collaborative teams and fully in the healthcare system, preventing the full capability and skill of the profession being utilised. - The barriers that exist for both our patients and all Australians in accessing timely care with the appropriate professional, at the appropriate time.
- The ACA has additionally provided written submission feedback at each stage of the review and on each scoping and draft document, advocating for the chiropractic profession and the patients they serve.
Report Findings
Among key findings, and well understood by health professionals on the ground, is an acknowledgement of the increasing complexity of patient needs, particularly with the rise of chronic conditions and an ageing population. The report also recognises the underservicing and poorer health outcomes experienced in our rural communities. These needs call for a more flexible and collaborative approach to healthcare delivery. The report emphasises the need for greater interdisciplinary collaboration, advocating for healthcare professionals, including chiropractors, to work more closely with other providers.
Additionally, the report stresses the importance of ensuring all primary care professions are practising to their full scope and highlights the necessity of updating education and training programs to keep pace with emerging healthcare needs.
Lastly, the report calls for regulatory reform to ensure that regulations, funding, and legislation is more flexible and standardised, allowing professionals to work across different regions and adapt to the changing healthcare landscape.
Key Recommendations
The final report proposes 18 key recommendations across four themes. From a chiropractic perspective, there are many recommendations that are encouraging, including (but not limited to):
- Recommendation 12 – Establishing direct referral pathways for allied health professionals to non-GP specialists under the MBS, aligned with their scope of practice, was a key proposal strongly recommended by the ACA for inclusion in the final report. For chiropractors, this recommendation supports direct referral for chiropractors to orthopaedic surgeons. Removing the cost and delay in accessing care associated with the indirect referral processes is of positive benefit for patients. If this recommendation is implemented successfully, the ACA will continue to advocate for an expansion of these referral pathways to other relevant specialists within the chiropractic scope.
- Recommendations 4 and 5 – Proposes support for greater multi-disciplinary team involvement, interprofessional primary care and collaborative education and practice. Chiropractors work well as part of the broader healthcare team and have a key role to play in managing chronic and acute musculoskeletal conditions, especially low back and neck pain. Additional support, education, and opportunities for Australians to access a multi-disciplinary team, including a chiropractor, has the potential to improve consumer health outcomes through improved access to appropriate, timely and patient-centred, care.
- Recommendation 16 shared definition of cultural safety – As the ACA completes its Innovate RAP, the recommendation to progress a system-wide shared definition of cultural safety supports and enables expansion of the work and commitment of the ACA’s Aboriginal Rural Remote Practitioner Network (ARRPN) in supporting chiropractors to develop their understanding and application of cultural safety.
- Recommendation 18 Rural and remote priority implementation – as a proud member of the NRHA, and with many of our members in rural and remote locations experiencing stretched health services and underserviced communities, we welcome this recommendation prioritising support for communities we know are experiencing poorer health outcomes.
The Development of a National Skills and Capability Framework
Underpinning all recommendations in the report is recommendation 1, developing a national skills and capability framework. The development of such a framework represents a complex piece of work. For chiropractic, the framework has the potential to allow other professions, health decision-makers, and health consumers to understand the full skill and competency of chiropractors. Ideally, the framework will enable health decision-makers to understand the full capability of the health workforce. This facilitates an environment for professions to be utilised to their full scope and to meet the health needs of the Australian population more effectively.
It will provide necessary information to shift from funding models linked to a restricted pool of named professions or services, to both blended funding models (recommendation 10) and expanded accessibility to all practitioners with relevant scope, where fee for service is still utilised.
The Future
Health Ministers are now considering the recommendations. We know that the adoption and implementation of any proposed changes is unlikely to be fast and will be a large body of work for the Association over the coming years as we participate and advocate for the profession at each stage. A culture of leadership and collaboration with all stakeholders is critical to the success of any reforms and the ACA is well positioned and experienced to provide this leadership for the profession. We look forward to ongoing opportunities to contribute the voice of the chiropractic profession to any associated reform of the healthcare system and to working with the government on the implementation plan and recommendations.