Workforce

The Productivity Commission report on Australia's health workforce identified workforce shortages across a number of health professions, particularly in rural and remote areas. The report acknowledged that developing technology, growing community expectations and the ageing population will increase demand on the health workforce. Strategies identified to address this problem include increased efficiency and effectiveness of the available workforce and the development of new models of care (Productivity Commission 2005).

We need to think creatively about the primary health care workforce in terms of role delineation, skill mix and education and training in order to support innovative models of integrated primary health care delivery such as HealthOne NSW.

Ideally, the workforce required to deliver of the HealthOne NSW model of care includes:

• General Practitioners
• Practice nurses(s)
• Community health nurses
• Allied health professionals (may be a mix of state funded community health and private professionals) such as physiotherapists, occupational therapists, dietitians, psychologists, social workers, podiatrists and Aboriginal health workers
• Health educator(s) such as diabetes educators and health promotion workers
• Business Manager / Data Manager
• Administration staff

The number of health professionals and skills required of them to deliver the HealthOne NSW model of care to a target population or an entire local population need to be considered. It is also necessary to consider the way in which the team is organised - the delineation of roles, task delegation (which professional completes which task) and task substitution (where a person from one professional background performs a task traditionally performed by another type of health professional) to maximise the use of the various skills of the team in order to provide effective and efficient care (Zwar et al 2007).

A current example of task delegation and substitution can be found in general practice, with the increasing emphasis on the role of practice nurses supported by the MBS Practice Nurse items. This allows more efficient use of the skills of the practice nurse and general practitioner. Similarly, there have been recent changes to the MBS to allow greater use of the allied health workforce. The predominant fee for service arrangements in general practice do however constrain which tasks can and cannot be delegated and substituted within the general practice component of a HealthOne NSW service.

The success of these strategies to implement new ways of working is dependent on professional respect, understanding of each others roles and building trust within the team. Supporting workforce changes with sound clinical governance, planning, team meetings and team activities can help foster understanding and respect.

Many General Practice and Community Health services carry full clinical loads and often experience workforce shortages, creating challenges in implementing the necessary service changes. Careful consideration needs to be given to these when developing and implementing a HealthOne NSW service. Once functioning fully, the HealthOne NSW model aims to maximise use of the current primary health care workforce and also attract new staff by offering professionally satisfying work environments.

Existing general practice and community health services may not have the current skill mix required to deliver the comprehensive HealthOne NSW model of care. Identifying education and training requirements and strategies to meet those requirements will be a necessary part of the HealthOne NSW service development. Universities and local General Practice Training Providers may be closely involved in the development of those HealthOne NSW services which have a strong training focus. For other services, links may be made over time to enable structured education and training activities to take place.

Ongoing education and professional development can have a positive impact on the workplace, by increasing staff confidence and competence and contributing to staff stability and morale, particularly in rural and remote areas (Humphries et al 2007).  Once established, HealthOne NSW services may also provide clinical placements for undergraduate and post graduate medical, nursing, and allied health students.