The Minister for Health and Aged Care the Hon. Mark Butler MP today announced welcome moves to strengthen Medicare and improve primary care access, securing two new Urgent Care Clinic providers and tripling the bulk billing incentive for GPs treating commonwealth concession card holders.  

These measures announced in the May budget form part of an overdue era of health system reform, but a greater pace of structural reform is required to overcome the inefficiencies in primary care and improve patient pathways.  

In interviews this morning, the Minister discussed the health workforce shortage and the need to have every single health worker operating at the top of their scope of practice to better meet population demand.  

Physiotherapists are experts in the diagnosis of musculoskeletal conditions. Their existing scope includes ordering tests and making referrals, but restrictive Medicare Benefits Schedule (MBS) rules limit this in practice.  

Australian Physiotherapy Association National President Scott Willis says this results in increased costs, time delays, and potentially delayed access to essential care for the patient.  

“We want these barriers removed to improve the patient journey and lower costs to the health system,” Mr Willis said.  

More money is spent on musculoskeletal disorders, than any other disease, condition or injury in Australia, at a cost of $14 billion¹, with the musculoskeletal burden impacting close to 7 million Australians².  

A report by The Grattan Institute last year found a “very significant gap” between the contribution physiotherapists are able to make to primary care and “what funding and policy let them do in Australia.”  

“Almost one in six GP visits are for a musculoskeletal issue, which evidence shows physiotherapists can provide expert diagnosis and treatment for without requiring a GP referral, as is now the model in the UK,” the report states.  

This model is called Funded First Contact Physiotherapy (FFCP).  

“FFCP trials were initiated in the UK to find more innovative models of care and to reduce the demand on GPs. It’s resulted in tens of thousands of patients avoiding hospital and costly surgery for health problems such as arthritis, back pain and muscle, bone and joint conditions just by seeing a physiotherapist,” Mr Willis said.  

In Australia, FFCP operates in a limited capacity within some emergency departments and to some extent, within the Aboriginal Community Controlled Health Organisations and private practice.  

“If FFCP already exists, and there is a very obvious need for adjustment to the current system, why are we still resisting better health outcomes and faster access to diagnosis and treatment?” Mr Willis said.  

In today’s interview, Minister Butler referred to a glass ceiling that has not allowed all health workforce skills and training to be used. He also discussed barriers that exist in referral pathways and removing unnecessary form filling exercises.  

Two simple solutions put forward by the APA to streamline the patient journey in primary care can be achieved now by allowing physiotherapists to directly refer patients to orthopaedic surgeons within their scope of practice and to expand medical imaging rights to physiotherapists.      

These changes are a simple step in shattering the glass ceiling and would remove structural inefficiencies, immediately improving patient pathways.  

“Advanced practice physiotherapists in emergency departments can refer to public hospital medical specialist-led clinics and order digital imaging, and in some states, they can order pathology tests.  

“These are skills that are already within the scope of all physiotherapists nationally, but that are restricted by systemic barriers entrenched in our Medicare system.

“The Minister is committed to driving the deeper structural reforms needed, recognising that a model of care that enables health disciplines to operate to their full scope of practice is the best way to deliver health care. 

“Primary care reform requires greater investment in publicly funded physiotherapy, improved access to physiotherapists as first contact practitioners, including in urgent care clinics and the removal of form filling exercises through the sensible reform of referral pathways,” Mr Willis said.  

The cost-effectiveness of physiotherapy interventions is proven both in the literature and through cost-benefit analysis. The APA has put forward evidenced reform solutions to the government, to help drive improvements in health system design, address inequities, and improve efficiencies.  

An interim report is due next month from the Unleashing the Potential of our Health Workforce – Scope of practice review.  

You can read the APA’s submission to the review here.