Doctors willing to share the load with caution

In a range of articles in the latest issue of the Medical Journal of Australia, medical professionals warn that any shift towards allowing nurses or surgical assistants to take on such tasks must be approached with extreme care.

Changing technology, growing community expectations and an ageing population are driving the push for task substitution in the medical workforce.

"Doctors embrace task substitution wherever it can be done safely and effectively," Australian Medical Association (AMA) Vice-President Dr Choong-Siew Yong said.

"(But) any reforms must improve what doctors and other health professionals do, rather than risk any reduction in standards of care.

"The AMA is calling for reforms that synergise the different skills of doctors, nurses and other health professionals, rather than for a competitive regimen of overlapping clinical roles.

"In doing this, there would be the capacity to extend medical services with efficiency gains but without the potential loss of safety or fragmentation of care."

The Productivity Commission has recommended that Australia allow more health professionals to undertake doctors' tasks, but Dr Yong emphasised that: "When people have any serious health problem they will want and expect to see a doctor, and so they should."

Professor John Collins, Dean of Education at the Royal Australasian College of Surgeons (RACS), said surgeons supported the evolution of the medical workforce but agreed that the doctor should remain central to any team-based care model.

Task substitution should not be used as an excuse for reducing the number of Australia's most highly-trained medical professionals, Professor Collins argued.

"A clear requirement needs to be identified for task transfer; it should not be used to avoid redressing the current inefficient use of existing surgeons resulting from ongoing underfunding," he said.

"The RACS supports the evolution of new health care roles in surgery provided a clear need is identified, a proper curriculum and standards are developed, and provided these health professionals work under supervision as part of a surgical team and in situations where clinical outcomes are monitored continuously."

Immediate past president of the Royal Australasian College of Physicians (RACP), Dr Jillian Sewell, said any widespread introduction of task substitution must be preceded by new education standards and assessments.

"Task transfer must be evidence-based, safe, cost-efficient and facilitate best patient care," Dr Sewell added.

The medical profession must accept task substitution as one solution to Australia's health workforce crisis, according to Professor Peter Brooks, Executive Dean of Health Sciences, University of Queensland.

"Like many professions … we still fail to acknowledge that others may be able to do what we do - perhaps even better in some cases," Prof Brooks said.

"Designing a health system that is both patient-focused and provider friendly . . . is a challenge that all health professions can work together on."

Professor Michael Kidd, President of The Royal Australian College of General Practitioners (RACGP), proposed six principles to appraise the potential risks and benefits of creating new health profession roles, or transferring responsibility.

He said the new roles should:

• Support the relationship between patients and their general practitioners;
• Be clearly defined, aligned with competency and with relevant professional registration;
• Be supported by practice systems providing safeguards against medical error;
• Be underpinned by a system ensuring informed patient consent to activities being undertaken by members of the general practice team;
• Be supported by effective medical indemnity insurance, and;
• Be supported with appropriate financing.

"There is scope for innovation in the tasks carried out in Australian general practice, but we need a structured way to assess options and ensure that potential risks are minimised and we need to consider the acceptability of changes," Prof Kidd added.

The Medical Journal of Australia is a publication of the Australian Medical Association.