Wfc Industry Skills Report Primary Health Care 2012-09-24

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Primary HealthCare SectorIndustry Skills and WorkforceDevelopment Report: June 2012


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The Workforce Council acknowledges Aboriginal and Torres Strait Islanderpeople as the original inhabitants of Australia and recognises these unique

cultures as part of the cultural heritage of all Australians. We respectfullyacknowledge the traditional custodians of the land on which we do our

work across Queensland. For more information on our commitment toReconciliation visit www.workforce.org.au/about/reconciliation

All portraits are a part of the Workforce Councils Photo Exhibitionhttp://www.workforce.org.au/gallery/our-people.aspx


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Contents

4 Industry Sector Profile5 Training Profile

8 Economic, social demographic, environmental andtechnological factors10 Government Policies impacting on the industrys

workforce13 Identification and Prioritisation of gaps between the

existing workforce and future workforce needs15 Demand and supply disparities18 Advice concerning training product, pathways, training

quality and delivery methods20 Key Achievements21 Ten Year Skilling and Workforce Development Outlook21 Five Year Skilling and Workforce Development Priorities22 Priorities for action over the next year

Primary Health Care SectorIndustry Skills and Workforce Development Report: June 2012 3


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This report summarises information related to the Queensland Primary Health Care Sector todate. It forms part of the Industry Skills and Workforce Development Report for the CommunityServices and Health Industries, June 2012. Information in this report has been validatedthrough consultation with industry stakeholders.

PROFILESIndustry sector profilePrimary health care is commonly viewed as the first level of care or as the entry point to the healthcare system for consumers.1 In addition, primary health care is increasingly being seen as all healthcare services provided outside the hospital.2 In the Australian context, a commonly used definition ofprimary health care developed by the Australian Primary Health Care Research Institute is: sociallyappropriate, universally accessible, scientifically sound first level care provided by health servicesand systems with a suitably trained workforce comprised of multi-disciplinary teams supported byintegrated referral systems in a way that: gives priority to those most in need and addresses healthinequalities; maximises community and individual self-reliance, participation and control; andinvolves collaboration and partnership with other sectors to promote public health.3

The most recognisable services in the primary care sector are general medical practices, the newMedicare Locals (replacing previous Divisions of General Practice), community health services,private clinics and Aboriginal medical services. In addition to providing direct medical care, theseservices also commonly provide allied health services such as physiotherapy, speech pathology,counselling and psychology services, acupuncture, etc. Many primary health services also providepreventive health, health promotion, education and care coordination services to the community.

Currently, the Australian primary health care system is facing workforce shortages.4 Though precise

quantification is difficult, there are evident shortages in general practice, various medical specialty areas,dentistry, nursing and some key allied health areas.5 Creating a strong, flexible and responsive primaryhealth care sector and workforce is critical given the complex, fragmented and often uncoordinateddelivery systems that operate across primary health care that have implications for the servicesindividuals receive, how they pay for them, and how care providers interact and provide care.6

The primary health care sector plays an important role in the health care system with four out of fiveAustralians attending a General Practitioner or other primary care professional at least once a year.7However, Australias primary health care sector operates as a disparate set of services, so instead ofa system it is often described in terms of occupations that work within it such as general practitioners,

1 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to SupportAustralias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012)2 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to SupportAustralias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012)3 Department of Health and Ageing, Commonwealth of Australia, Primary Health Care Reform in Australia: Report to Support Austra-lias First National Primary Health Care Strategy. (Canberra, 2009), 24.4 Australian Institute of Health and Welfare. 2009. Health and community services labour force 2006.National health labour forceseries no. 42. Cat no. HWL 43. Canberra: AIHW5 Productivity Commission, Australian Government. 2005. Australias Health Workforce, Productivity Commission report on Australiashealth workforce. http://www.pc.gov.au/__data/assets/pdf_file/0003/9480/healthworkforce.pdf (accessed April 4th 2012)

6 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to SupportAustralias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012)7 Commonwealth of Australia. 2011. National Health Reform - Improving Primary Healthcare for all Australians. http://www.healthis-suescentre.org.au/documents/items/2011/02/363952-upload-00001.pdf (accessed March 3rd 2012)

Health and Community Services Workforce Council4


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practice nurses, psychologists, physiotherapists, community health workers, and pharmacists.8

Training ProfileQualifications in Aboriginal and/or Torres Strait Islander Primary Health Care represent the mostsignificant area of delivery for the primary health care sector. These qualifications are directly

related to Indigenous Health Worker roles within Queensland Health as well as Health Workersemployed in Aboriginal Medical Services. Delivery of the Certificate III peaked in 2008/09following the introduction of this qualification in the 2007 Health Training Package. Numbers in thisqualification have dropped in the following two years and on the basis of data for the period 1 July2011 to 31 March 2012, enrolments this financial year will be similar to 2010/11. Enrolments inthe Certificate IV are gradually increasing thanks to targeted strategies in both Queensland Healthand the Aboriginal Medical Services.

The General Practice sector in Queensland has begun utilising national training packagequalifications, and some of the Medicare Locals and the state body are delivering training inpartnership with registered training organisations. As a result, delivery of Practice Managementand Population health qualifications is emerging. The Certificate IV in Medical Practice Assisting isdesigned to support an emerging role for administration staff in general practice to support patientcare.

8 Department of Health and Ageing, Commonwealth of Australia. 2010. Building a 21st Century Primary Health Care System Austra-lias First National Primary Health Care Strategy. http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/3EDF5889BEC00D98CA2579540005F0A4/$File/6552%20NPHC%201205.pdf (accessed March 4th, 2012)



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Current industry and workforce reforms are beingdriven through national and state governmentpolicies and mandates which are vital in altering

the structural design of the system

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Indigenous Environmental Health qualifications are used by Queensland Health to support arelatively small workforce in Indigenous communities in the Cape and Gulf regions.



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CHALLENGES IMPACTING ON THE INDUSTRYS WORKFORCE

Economic, social demographic, environmental andtechnological factorsThe demand for primary health care services is expected to increase due to such factors as therise in chronic and complex disease, an ageing population with multiple co morbidities, workforceshortages in other parts of the health system, geographical dispersion, increasing health care costs,advances in technology and changes in inter-professional service delivery models of care.91011

A health system approach advocated by government reports has implications for workforcedevelopment. These approaches include utilising the social determinants of health promoted bythe World Health Organisation as a tool for locating specific pre-dispositions to disease acrossQueensland to inform deployment of health care workforce.

Current industry and workforce reforms are being driven through national and state government

policies and mandates which are vital in altering the structural design of the system. However,the implementation of workforce changes ultimately occurs at the local level by practitioners andorganisations themselves across private, public and non-government environments. Queenslandvaries from other states in many areas including population, distribution of population andworkforce, impact of resources boom and the political environment which all shape the local,regional and state landscape. This creates an imperative to understand the Queenslandenvironment to inform an appropriate and effective approach to the implementation of workforcestrategies.

Demographics

The primary health care workforce, based on people employed in general practice medical servicesand community-based dental, allied health and pharmacy services, including nurses, is around137,600 equating to approximately 25% of the health workforce (Department of Health and Ageing2009, Australian Institute of Health and Welfare 2006). This includes 20% of the 17,700 medicalspecialists in Australia who work in primary care settings (Australian Institute of Health and Welfare2006). From an international perspective, Australia is not considered to have a critical shortage ofhealth workers, the number of people working in health occupations increased by 11.4% comparedwith an 8.7% increase in the total civilian workforce.12

In 2002 Queensland had the lowest number of registered medical practitioners per head ofpopulation in Australia, decreasing from 236 per 100,000 in 1997, to 220 in 2002. This isparticularly concerning when Queensland has experienced unprecedented levels of populationgrowth. Outside capital cities, the fastest growth in 2008-09 occurred along the Australian coastespecially in the regional areas of the Gold Coast, Sunshine Coast, Townsville and Cairns inQueensland.139 National Health and Hospitals Reform Commission, A Healthier Future For All Australians Final Report of the National Health andHospitals Reform Commission. (Canberra, 2009);, http://www.biomedcentral.com/1472-6963/8/24910 Tran, D. et al, Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results fromexpert panels, BMC Health Services Research 8 (2008)11 Humphreys and Wakerman. Primary health care in rural and remote Australia: achieving equity of access and outcomes throughnational reform, (2008).12 World Health Organisation. 2008. Closing the gap in a generation: health equity through action on the social determinants ofhealth. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. http://whqlibdoc.who.int/publi-cations/2008/9789241563703_eng.pdf (accessed February 26th 2012)13 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March25th 2012)



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There is however, significant disparity in the number of health careprofessionals between metropolitan and the most remote parts of

Australia.14 In 2006 the most remote areas had significantly fewergeneral medical practitioners, registered nurses and allied health workersper 100 000 population compared to major cities - 64 allied healthworkers per 100 000 population compared to 354 per 100 000 in major

cities.15 This pattern of health worker disparity in rural and remote areasis exacerbated within the primary health care workforce.

Components of that growth are important for establishing healthcare where the service is needed. In 2006, Queensland had thesecond largest number of Aboriginal and Torres Strait Islander people(144,900) after NSW (152,700), however, the Indigenous populationof Queensland is projected to be the fastest growing of the states andterritories which will grow by 34.9% by 2021.16 There are significant gapsin Indigenous participation in the health workforce. There is a relatively

small number of Indigenous people in the health workforce and ashortage of workers, particularly health professionals, in indigenous health. In2006, while Aboriginal and Torres Strait Islander people made up 3.5% of thepopulation of Queensland, only 1.4% of the health workforce was indigenous(Australian Institute of Health and Welfare 2008). These workers are unevenlydistributed across the state in ways that impact on Aboriginal and Torres StraitIslander health services.

Ageing WorkforceGenerational changes mean that many providers are not working the samelong hours or practising in the same way as their predecessors17 The informalcarer workforce currently providing much of the services to the aged18 is likely todiminish as people stay longer in the workforce and are less available to assistthe aged and chronically ill to stay at home.

The warning is that number alone will not address the ageing workforcechallenges. Regard for the types of needs of the community and matchingthe skills to those needs is essential with an overarching focus on well-ness toprevent disease.

Workforce planning is considered a major problem in the primary health care

sector for Aboriginal and Torres Strait Islander services. The Queensland Aboriginal and TorresStrait islander Health Council (QAIHC) advocates under the reform of Medicare Locals a newmodel of the QAIHC Comprehensive Primary Care Model in response to the workforce impacts onservice provision for the Indigenous part of the sector. This model relies on a Community HealthPlan and a Health Services Plan. Thorough though this model is, it relies on exponential growth in14 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March25th 2012)15 Australian Institute of Health and Welfare. 2009. Health and community services labour force 2006.National health labour forceseries no. 42. Cat no. HWL 43. Canberra: AIHW16 Australian Bureau of Statistics. 2009. Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991to 2021. Cat. No 3238.0, 2009, Australian Bureau of Statistics. http://www.abs.gov.au/ausstats/[email protected]/mediareleasesbytitle/5D8264F4B083F282CA25762A002726E3? (accessed 24/04/12)

17 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Action 20112015.https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April 20th 2012) page 318 Productivity Commission, Australian Government. 2005. Australias Health Workforce, Productivity Commission report on Australiashealth workforce. http://www.pc.gov.au/__data/assets/pdf_file/0003/9480/healthworkforce.pdf (accessed April 4th 2012)



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the workforce and the expansion of current knowledge and skills tomove to a community approach to the social and environmental

determinants of growth.

Workforce disadvantage in the Indigenous sector of primaryhealth care has two aspects. The first is the relatively small

number of Indigenous people in the health workforceand the second is the shortages of workers, particularly

health professionals, in Indigenous health.

In 2006, while Aboriginal and Torres Strait Islanderpeople made up 3.5% of the population of

Queensland, only 1.4% of the health workforcewas Indigenous.19 Nationally, only 0.2% ofGPs, 0.2% of specialists, 0.4% of midwives,

1.0% of nurses in community health and 0.6%

of nurses working in mental health were Indigenous.These figures demonstrate significant gaps in Indigenous

participation in the health workforce which is a major problemgiven national and international recognition of the importance

of engagement of communities in their own primary health care ifappropriate outcomes are to be achieved. Shortages of workers in Indigenous

health are widely acknowledged.

Queensland is the countrys most decentralised state and in 2002 it had the lowest numberof registered medical practitioners per head of population in Australia, decreasing from 236 per

100,000 in 1997, to 220 in 2002. These will be unevenly distributed across the state in ways thatimpact on Aboriginal and Torres Strait Islander health services. National data show that the FullTime Employment (FTE) rate of employed primary care practitioners was highest in areas where lessthan 1% of the population was Indigenous (108 per 100,000 population) and lowest in areas wheremore 10% of the population was Indigenous (87 per 100,000 population).20 Other professionsare also in short supply in Queensland including experienced nurses and allied professionals,especially in rural and remote areas where many Aboriginal and Torres Strait Islander people live.21

Government policies impacting on the industrys workforceNational Health and Hospitals Reform

One of the key initiatives of the National Health and Hospitals Reform is the establishment ofMedicare Locals from the previous Divisions of General Practice. Medicare Locals have beencreated as independent legal entities (not government bodies) and act as regional primary healthcare organisations. Medicare Locals have entirely new governance arrangements for the provisionof primary health care than previously was the case under Divisions. These primary healthcare organisations are charged with responding to the health needs of their communities. Theintroduction of primary health care organisations in Australia follows the international trend withthe establishment of Primary Care Trusts in the United Kingdom and Primary Health Organisations

19 Australian Institute of Health and Welfare. 2008. Aboriginal and Torres Strait Islander Health Performance Framework, 2008 report:Detailed analyses. Cat. no. IHW 22

20 Australian Institute of Health and Welfare. 2008. Aboriginal and Torres Strait Islander Health Performance Framework, 2008 report:Detailed analyses. Cat. no. IHW 2221 Queensland Government. 2005. Queensland Strategy for Chronic Disease 2005-2015, promoting a healthier Queensland. http://www.health.qld.gov.au/chronicdisease/documents/strat2005to15_full.pdf (accessed February 13th 2012)



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in New Zealand22 (Department of Health and Ageing 2009). Both the New Zealand and UnitedKingdom primary health care arrangements have been established for close to ten years. Learningfrom these experiences particularly in terms of the potential funds management role and the impactof this would prove useful in shaping Australian policy.

Through the National Health and Hospital Reform Queensland has a total of 11 Medicare Locals.The 11 Medicare locals were introduced through a staged National process between 1 July 2011and 1 July 2012.23 Adding to this environment of change is a range of state based policy initiativeswhich directly impact on the primary health care sector. These include: the Queensland Chronic Disease Strategy 2006-201524 The Health Consumer Queensland Consumer Engagement Framework25 (Health Consumer

Queensland), Securing a Skilled Future Skills and Workforce Development Investment Plan, 2012-2013,26 and The Queensland Compact.27

In the midst of the roll out of national and state reforms and policy initiatives, 2012 saw a changein government in Queensland to the Liberal National Party. What focus the government will placeon the on the primary health care sector and its policy position on the national reforms remainsto be seen. None the less, the sectors ability to attract attention and investment levels required tosuccessfully implement change framed through the national reforms must remain an area of priorityfor the primary health care sector.

The currency and size of some reforms for example, the establishment of Medicare Locals, requiresgreater clarity as to their impact and role in workforce reforms and workforce issues. This includeskey elements such as clarity about the governance arrangements of organisations involved inimplementing primary health care workforce reforms.28 Consequences of other reforms such asthe introduction of an entitlement model within the Vocational Education System are also yet to beclearly understood. The entitlement model will allow individuals to choose their course and theirregistered training organisation funding following them. This may result in significantly increasedpublic investment in the training system and an altered relationship between student and trainingorganisation.29

Industrial and RegulatoryThe reform around Medicare Locals with independence from uniform industrial relations ispredicted to impact each Medicare Local as it undertakes workforce planning to meet the needsin each community. The new environment in primary health care will have implications for the

22 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to SupportAustralias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012)23 Department of Health and Ageing (n.d.) My Medicare Local. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/con-tent/medilocprofiles. (accessed February April 4th 2012)24 Queensland Government. 2005. Queensland Strategy for Chronic Disease 2005-2015, promoting a healthier Queensland. http://www.health.qld.gov.au/chronicdisease/documents/strat2005to15_full.pdf (accessed February 13th 2012)25 Health Consumer Queensland, Queensland Government . 2012. Consumer and community engagement framework. http://www.health.qld.gov.au/hcq/publications/consumer-engagement.pdf (accessed April 24th 2012)26 Skills Queensland. 2012. Skills and Workforce Development Investment Plan 2012-2013. People Potential Prosperity http://www.skills.qld.gov.au/Functions/Workforce-development/skills-and-workforce-development-investment-plan.aspx#Securingaskilledfuture (accessedMay 3rd 2012)27 Queensland Government. 2008. Queensland Compact. Towards a Fairer Queensland. http://www.communities.qld.gov.au/commu-nityservices/about-us/corporate-plans/queensland-compact-towards-a-fairer-queensland (accessed February 12th 2012)28 Naccarella.L., Buchan, J., and Newton. B., and Brooks, P. 2011. Role of Australian primary healthcare organisations (PHCOs) in

primary healthcare (PHC) workforce planning: lessons from abroad Australian Health Review 35: 262266. www.publish.csiro.au/journals/ahr(accessed March 15th 2012)29 Health and Community Services Workforce Council. 2012. Queensland State Election, Policy Analysis. Unpublished document - Pre-pared for Queensland Industries Reference Group Meeting 29 March 2012



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identity of the primary health care sector. For example, Medicare Locals are charged with strongerengagement with the aged and community care sector, a sector which has recently amalgamated anumber of organisations to produce a single national voice.

Workforce reforms underway focus on increasing workforce supply through education/traininginitiatives, changing the skill mix and extending the roles of health workers to improve resource

utilisation and better meet patient needs.30 Some examples of system wide workforce initiativesinclude substantially increasing the number of clinical training places; establishing lead agenciesand entities including, Regional Clinical Training Networks, Health Workforce Australia, a singleNational Registration and Accreditation Scheme, and the progression of the national e-healthstrategy.

There are current regulatory barriers to ongoing reform of the health workforce with professionalaccreditation bodies policy and practices being both enablers and barriers to workforce reform.Health related reform initiatives and strategies are being progressed to improve health services andincrease the health workforce in rural and remote areas that ultimately can improve the health and

welfare of Indigenous Australians. These include the Closing the Gap initiatives through the Councilof Australian Governments,31 the development of a Rural and Remote Health Workforce Innovationand Reform Strategy by Health Workforce Australia32 and the production of a 20 point plan twentysteps to equal health by 2020 by the National Rural Health Alliance.33

Exacerbating and limiting workforce change are industrial and regulatory issues which needto be addressed to realise fundamental changes in job design, scope of practice, professionaldemarcation and the creation of new roles.34 Such examples include different industrial instrumentsacross private, government and non-government funded services, rigid regulatory arrangementsoften influenced by professional groups and the inflexibility and inconsistency in regulatory andaccreditation arrangements. These issues have a significant impact on the ability of the workforceto introduce changes such as creating new roles and or expanding the scope of others. This isof particular relevance for the primary health care sector where a key concept underpinning theapproach within the sector is the role of the health professional as part of a health care team, whichis vital in the management of chronic disease.35 The National Accreditation Scheme introducedin 2009 does attempt to address some of these issues through the introduction of nationalaccreditation and registration arrangements for key professions. In particular Aboriginal Health

Worker accreditation has produced problems which are outlined later in the report.

TechnologyThe National e-health strategy whilst not a specific workforce reform will have a substantial impact

on how the workforce operates. Operating in a more electronic and technologically connectedenvironment will require not only system and structure changes but a particular focus on enhancingthe skills and capability of the workforce. The building of Australias E-Health skills capacity and

30 Brooks, P., Ellis, N. 2007. Health workforce reforms, Workforce rising to the challenge. http://cpd.org.au/article/health-workforcere-form-rising-to-the-challenge [Verified July 2008] (accessed 16th March 2012)31 Queensland Aboriginal and Islander Health Council. 2011. A Blueprint for Aboriginal and Islander Health Reform in Queensland.Official Launch October 2011. http://www.qaihc.com.au/resources/publications/ (accessed March 15th 2012)32 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March25th 2012)33 National Rural Health Alliance. 2012. Twenty Steps to Equal Health by 2020: The NRHAs 20-Point Plan for improving health servicesand health workforce in rural and remote areas. http://nrha.ruralhealth.org.au/cms/uploads/publications/twenty_steps_to_equal_health_for_website_11may2012.pdf (accessed April 12th 2012)

34 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Action 20112015.https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April 20th 2012)35 Brooks, P., Ellis, N. 2007. Health workforce reforms, Workforce rising to the challenge. http://cpd.org.au/article/health-workforcere-form-rising-to-the-challenge [Verified July 2008] (accessed 16th March 2012)



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capability will require the national coordination of changes to vocational andtertiary training programs.36

Identification and prioritisation of gaps between

the existing/ forecasted workforce and futureworkforce needsMajor national health initiatives in recent years have emphasised the need for thehealth industry to refocus on wellness, prevention and primary health care if it isto be sustainable in the future. Such a change will require re-configuringnot only the workforce but the education and training programs thatprepare and support them.3738 Meeting the aims of primary healthcare is labour-intensive and calls on many professions. Australiais facing a primary health care workforce shortage exacerbatedby increasing complexity and fragmentation in the health

system.3940

The key challenges for Australias primary healthcare workforce are across the areas of supply, distribution,changing demands, and role delineation.41

Workforce planning in the health industry has traditionallybeen based around professions and occupations. A shifttowards methods, including models of care approaches thatfacilitate the integration of new approaches to workforcedesign and workforce planning has been emphasized.42Despite this over the last 10 years workforce planning hascontinued to be organized around professions, not targetedto primary health care specifically, and has been responsiveprimarily to funding streams.43 To achieve the shift from professionand discipline-based workforce development requires fundamentalstructural and cultural change.44

These mechanisms have driven a continued focus on Australian health andworkforce reforms and have recognised the need to think differently and re-engineerour system and our workforce to focus more on the primary health care setting. Whilst

36 Australian Health Ministers Advisory Council. 2008. National e-health Strategy Summary, December 2008. http://www.ahmac.gov.au/cms_documents/National%20E-Health%20Strategy.pdf (accessed 23rd May 2012).

37 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Ac-tion 20112015. https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April20th 2012)38 Commonwealth of Australia. 2008. A long-term national health strategy. Australia 2020 Summit Final Report.http://www.australia2020.gov.au/docs/final_report/2020_summit_report_5_health.pdf (accessed March 15th 2012)39 Commonwealth of Australia. 2005. Australias Health Workforce. Research report. Canberra. http://www.pc.gov.au/__data/assets/pdf_file/0003/9480/healthworkforce.pdf [Verified September 2008] (accessed March 17th 2012)40 Council of Australian Governments. 2006. COAG Response to the Productivity Commission Report on AustraliasHealth Workforce. http://www.coag.gov.au/coag_meeting_outcomes/2006-07-14/docs/attachment_a_response_pc_health_workforce.pdf [Verified October 2008 (accessed April 3rd 2012)41 Douglas, K. A., Frith. K., Laurann, L. E., Wells, R. W., Glasgow, N. J., Humphreys, J. S.. 2009. Australias primaryhealth care workforce research informing policy. Medical Journal of Australia Volume 191 Number 242 Australian Health Workforce Advisory Committee and Australian Medical Workforce Advisory Committee. 2005. AModels of Care Approach to Workforce Planning - Information Paper, Health Workforce Information Paper 1, Sydney. http://www.ahwo.gov.au/documents/Publications/2005/A%20models%20of%20care%20approach%20to%20health%20work-force%20planning.pdf (accessed March 14th 2012)

43 Brooks, P., Ellis, N. 2007. Health workforce reforms, Workforce rising to the challenge. http://cpd.org.au/article/health-workforcereform-rising-to-the-challenge [Verified July 2008] (accessed 16th March 2012)44 Francis, S., Carswell, P., North, N., Gauld, R., Brooks, P., Wakerman, J. 2010. Commentary - Challenging Workforceplanning approaches Asia Pacific Journal of Health Management 2010; 5:2



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the importance of the primary health care sector is specifically acknowledged through BuildingBlock 3: A Skilled Workforce within the National Primary Health Care Strategy45 there is a lackof targeted and tailored attention to lead an industry driven whole of primary health care sectorworkforce vision and related workforce strategies at national and state levels. Although thereis recognition that alternate approaches to workforce planning are required, a lack of debateexists about primary health care workforce planning, despite the national emphasis on overall

strengthening of the primary health care system.46 There continues to be insufficient investment inresearch and workforce development in primary health care in Australia.47

The primary health care system is complex and there is acknowledgment of the need to build thecapacity of the sector to shift the paradigm of health care in Australia. Facilitating change in anenvironment characterised by extreme politicisation, power inequities created through stronglyestablished occupational hierarchies, confusing and ineffective funding mechanisms and a lackof a whole-of-system approach to building capacity is a challenge for practitioners, managersand leaders. The lack of clarity and debate concerning the approach to the primary health careworkforce hampers the ability to facilitate a whole-of-sector approach to planning.48 There

continues to be inconsistent interpretations of the sector by experts within it concerning the scope ofservice and support within the sector; and an ongoing preference to describe the sector in terms ofoccupations.

45 Department of Health and Ageing, Commonwealth of Australia. 2010. Building a 21st Century Primary Health Care System Austra-lias First National Primary Health Care Strategy. http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/3EDF5889BEC00D98CA2579540005F0A4/$File/6552%20NPHC%201205.pdf (accessed March 4th, 2012)46 Naccarella.L., Buchan, J., and Newton. B., and Brooks, P. 2011. Role of Australian primary healthcare organisations (PHCOs) inprimary healthcare (PHC) workforce planning: lessons from abroad Australian Health Review 35: 262266. www.publish.csiro.au/journals/ahr(accessed March 15th 2012)47 Public Health Association of Australia. 2011. Policy at a glance, primary health care policy. http://www.phaa.net.au/policyStatemen-

tsInterim.php#p (accessed March 18th 2012)48 Naccarella.L., Buchan, J., and Newton. B., and Brooks, P. 2011. Role of Australian primary healthcare organisations (PHCOs) inprimary healthcare (PHC) workforce planning: lessons from abroad Australian Health Review 35: 262266. www.publish.csiro.au/journals/ahr(accessed March 15th 2012)

PRIORITIES Increase capacity of the sector to carry out workforce planning based onagreed scope of the primary health care sector

Explore new models which provide for discipline-based workforce

development in addition to the more traditional professional based workforcedevelopment Increase the provision of training and development in workforce management

of multi-disciplinary teams in integrated service models of care Increase leadership and change management training and professionaldevelopment to ensure a capacity to prepare and manage a diverse andflexible workforce

Training and development programs redesigned to enable new and changedroles and respond to the multiple reforms in the industry.

Increase provision of training and skills in areas expected to increase indemand into the future including dementia care, counselling and communitymental health.



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Demand/supply disparitiesAttracting and retaining workers to the primary health care sector is a core driver in currentworkforce reforms. As with the health industry more broadly, primary health care currently struggleswith a lack of suitable and skilled workers to fill current roles.

A pressing area of concern currently is the registration of Aboriginal and Torres Strait IslanderHealth Practitioners. Currently there is a gap in the delivery of the Cert IV Aboriginal and TorresStrait Islander Primary Health Care (Practice) qualification which is the requirement for AboriginalHealth Workers to be registered as Practitioners. A number of Registered Training Organisations(RTOs) have this qualification on their scope. The supply is impacted by the capacity of RTOsto meet the requirements of the qualification with problems of funding, appropriately trainedstaff and clinical placements. There is a need within the sector to attract and then retain workerswho understand the philosophy and approach to primary health care broadly, particularly interms of self-management and care. One critical role the education system has in achieving thisneed is ensuring that the education system itself prepares the future workforce by integrating theappropriate and changing philosophies of primary health care in its curriculum. Educators will

need to play a strong role in developing a future workforce that is not only clinically and technicallycompetent but which also understands the context and aspirations of primary health care and itsrole in meeting those objectives.

In the context of a shift in balance of care from acute to primary care examining the implicationsfor skill mix and identifying areas of skill development required will be vital.49 This is particularlycomplex given the scope of the primary health care workforce which encompasses not onlytraditional or clinical health workers. Workers such as personal carers, assistants and supportworkers, promotion, prevention and early intervention workers and indigenous health workers area critical part of the overall primary health care sector. In addition to the diversity of the workforce

within the sector are the changing expectations of workers about their work and in particular thehours they are prepared to work.

Worker preferences are influencing the overall supply as workers opt for fewer hours or moreflexible working arrangements.50 Given these complexities strong management and leadershipcapacity to steer the sector through the current and future changes will be needed. The need forleadership is broadly acknowledged however the value of management is often underrated, andit is this group that has expertise in issues of change management, workforce development andbehavioral change.51 To truly transform the delivery of care it is critical to invest in the changemanagement skills required to alter the patient journey, professional roles, funding mechanisms,people and organisational culture.52

Another side to the supply side is that the new jobs created by the Closing the Gap and theMedicare Local policy requiring new clusters of skills for Aboriginal and Torres Strait Islanderworkforces particularly. There is a need for capacity to be developed particularly for the Closingthe Gap workforce, such as the tobacco action workers, healthy life style workers and IndigenousOutreach Workers. Currently, there are no specific career pathways for these positions even though

49 Public Health Association of Australia. 2011. Policy at a glance, primary health care policy. http://www.phaa.net.au/policyStatemen-tsInterim.php#p (accessed March 18th 2012)50 National Health Workforce Taskforce. 2009. National Health Workforce Taskforce, Health Workforce in Australia and Factors forCurrent Shortages April 2009. http://www.ahwo.gov.au/documents/NHWT/The%20health%20workforce%20in%20Australia%20and%20fac-tors%20influencing%20current%20shortages.pdf (accessed 16th March 2012)

51 Francis, S., Carswell, P., North, N., Gauld, R., Brooks, P., Wakerman, J. 2010. Commentary - Challenging Workforce planning ap-proaches Asia Pacific Journal of Health Management 2010; 5:252 Francis, S., Carswell, P., North, N., Gauld, R., Brooks, P., Wakerman, J. 2010. Commentary - Challenging Workforce planning ap-proaches Asia Pacific Journal of Health Management 2010; 5:2



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the responsibility for this workforce can be quite complex and in most cases there have only beencertain skills sets and orientation programs identified and developed by the Aboriginal ControlledCommunity Health Services sector to address workforce development.

The other major concern for Aboriginal Health Worker workforce is the gap in school-basedtraining delivering health qualifications traineeships/apprenticeships and particularly delivering the

Aboriginal and Torres Strait Islander Primary Health Care qualifications. Some of the major problemto date is the capacity of RTOs and schools to establish from scratch the coordination and deliverythese qualifications given that lack of experience with the training package HLT 07 for school-based qualifications and the commitment and capacity of schools to introduce Health traineeships/qualifications in general.

At the state level there is currently a strong economic outlook driven by a strong resources sectorand the consequent workforce demand is having an impact on the primary health care sectorworkforce.53 This creates competition for staff with the mining sector in some regional areas thatare being leaving the sector in pursuit of attractive wages and conditions offered by the mining

sector. There is a need for the recognition that a strong primary health care environment is vital forthe sustainability of communities. Involving primary health care and the broader health industryin cross-industry and regional economic planning is vital to ensure a coordinated place-basedapproach that balances competing requirements in the interests of regional communities.

53 Skills Queensland. 2012. Skills and Workforce Development Investment Plan 2012-2013. People Potential Prosperity http://www.skills.qld.gov.au/Functions/Workforce-development/skills-and-workforce-development-investment-plan.aspx#Securingaskilledfuture (accessedMay 3rd 2012)

PRIORITIES Develop strategies to increase skills in workforce management of multi-disciplinary teams in integrated service models of care and complex servicedelivery across organisations and institutions.

Raise awareness of primary health careers to increase participation andretention of Aboriginal and Torres Strait Islander people in the primary healthcare workforce

Support the leadership capacity of the Aboriginal and Torres Strait Islanderhealth workforce

Create capacity to supply increased number of Aboriginal Health Workers tosatisfy requirements of the regulatory body

Increase the capacity of the education and training sector to deliver CertificateIV in Aboriginal and Torres Strait Islander Primary Health Care

Develop industry led initiative which aims to identify the skill mix requirementsand consequent skill gaps

Implement prolongation and participation programs for the ageing workforcesuch as re-entry programs, refresher courses, occupational transition,knowledge management programs.



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There is a need for the recognition that a strongprimary health care environment is vital for the

sustainability of communities

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Advice concerning training product, pathways, training qualityand delivery methods

As service delivery changes, there is an increased need for high level skills in workforcemanagement, workforce planning, change management and innovation as services will increasinglybe required to adapt to their surroundings as they keep up to date with changing policy and client

expectations of the service. Efficiency, cost-effectiveness and return on investment will be increasinglyimportant in the design and delivery of services and workforce models.

Flexible, responsive and contemporary education models and pathways which allow mobility withinand throughout the health industry and primary health care sector are a significant challenge.There is a need to develop career structures and training pathways for workers that enablecareer development in the primary health care setting.54 To attract and retain a sustainable healthworkforce requires multiple entry points to health training and careers, starting at school levelwith programs that will articulate through the whole education framework.55 There is currently aheavy focus on preparing primary health care students through hospital placements which does

not encourage or prepare them to work in the primary health care setting should they choose thispath.56 Facilitating a breadth of clinical placements which include the primary health care setting iscritical in creating a career pipeline.The tertiary sector needs to support a range of programs, both specialised and general, to meetthe range of short course and professional certificate educational needs, preferably within aflexible model that allows articulation with formal qualifications.57 Significant barriers exist betweenprofessional disciplines and within training institutions and these impede the ability to furtherdevelop and implement a more multi-disciplinary approach and broader scope of practice.58

Within clinical education and training of health professionals, there is a relative lack of inter-disciplinary learning opportunities, or horizontal integration of curriculum. A lack of corecompetency based framework as part of teaching and learning curricula for health workforce hasbeen acknowledged.59 Education reforms attempt to address some of these outlined challenges andissues. These reforms include the Review of Australian Higher Education (2008) which is drivingchanges in the university sector and integrated package of reforms, Skills for Prosperity a roadmap for vocational education and training, developed by Skills Australia, the National Skills Body.

In early 2012, one of the two Aboriginal community controlled RTO delivering health qualifications,ATSICHET, folded. This has left a significant gap in the capacity of the Queensland trainingsystem to deliver the Aboriginal and/or Torres Strait Islander Primary Health Care qualifications.Unfortunately, this is occurring at the same time that theTraining Initiatives for Indigenous Adults

in Regional and Remote Communities (TIFIARRC) funding program has been discontinued. Therehave also been concerns about the quality of delivery of these qualifications in Queensland,and concerns from some of the community controlled sector that some TAFE institutes have been

54 Douglas, K. A., Frith. K., Laurann, L. E., Wells, R. W., Glasgow, N. J., Humphreys, J. S.. 2009. Australias primary health care work-force research informing policy. Medical Journal of Australia Volume 191 Number 255 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Action 20112015.https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April 20th 2012)56 Commonwealth of Australia. 2009. A healthier future for all Australians - Final Report of the National Health and Hospitals ReformCommission. http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/1AFDEAF1FB76A1D8CA257600000B5BE2/$File/Final_Report_of_the%20nhhrc_June_2009.pdf (accessed March 3rd 2012)57 Bennett, C. M., Lilley, K., Yeatman, H., Parker, E., Geelhoed, E., Hanna, E. G., Robinson, P. 2010. Paving Pathways: shaping the PublicHealth workforce through tertiary education. Australia and New Zealand Health Policy 2010, 7:258 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March

25th 2012)59 Commonwealth of Australia. 2009. A healthier future for all Australians - Final Report of the National Health and Hospitals ReformCommission. http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/1AFDEAF1FB76A1D8CA257600000B5BE2/$File/Final_Report_of_the%20nhhrc_June_2009.pdf (accessed March 3rd 2012)



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PRIORITIES Expand the scope of clinical training placements to maximize learningopportunities and future career choices in the primary health care sector

Clearer articulation of training and career pathways for workers throughimproved collaboration across education systems

Explore more flexible models of delivery of education and training Increase inter-disciplinary learning opportunities and horizontal integration ofcurriculum

Greater use of skill sets to augment current qualifications. Support for regional clusters of service providers, education and training

providers and policy-makers to facilitate regional workforce planning, roledesign and regional training networks.

Improve industrys understanding of VET and industrys role in influencingthe training system and the training they purchase. including strengtheningcollaboration stakeholders at the regional level.

Explore the capacity for e-learning and e-health in parallel with the roll out ofthe National Broadband Network.

Instigate contemporary learning models to better prepare a workforce forinitiating innovation in the emerging policy environment

Investigate the capacity of training providers in Queensland to deliver ATSI

Primary Health Care qualifications to meet industrys need. This assessmentshould include the availability of Aboriginal and/or Torres Strait Islandertrainers and viability in the absence of TIFIARRC

delivering the qualifications without Indigenous staff.

There is an urgent need to assess the capacity of training providers in Queensland to deliver thesequalifications and whether this capacity meets the level of demand. This assessment should includethe availability of Aboriginal and/or Torres Strait Islander trainers and viability in the absence ofTIFIARRC.



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KEY ACHIEVEMENTS

Workforce Council continues to support the Health Leaders Group in partnership with keyindustry, training and government stakeholders committed to seeking innovative solutions to ourhealth workforce crisis. A range of initiatives commenced through the health skills formationstrategy continues through funded initiatives and industry partnerships:

o Chronic condition self-managemento Indigenous healtho Health careers promotiono Overseas skilled health professionalso Recognized prior learningo School-based traineeships in healtho Health career pathwayso Articulation and Recognition to higher education

Planning for your Medicare Local Breakfast Seminaro In June the Workforce Council hosted a breakfast seminar exploring the workforce

implications of health reforms.o Over 75 representatives from government departments, peak bodies and service

providers attended to discuss the workforce implications of the Medicare Locals schemeand the need to integrate strategic workforce planning within the new primary health carestructure.

o The seminar marked one of the first opportunities for Queensland industry representativesto collectively explore relevant issues.

o Focused on the vital need for strategic workforce planning to support the new healthreforms, outlining some of the key elements and strategies necessary for such a regionalworkforce planning process.

Outcomes for the seminar included:o Workforce Council has continued engagement with health industry stakeholders,

consulting with members of the Health Leaders Group, General Practice QueenslandReference Group, Community Health Services Network Group and Medicare Locals.

o The June 2012 Industry Skills Body report will have a stronger emphasis onPrimary Health Care and will focus on the workforce skilling and planningneeds for the Health Industry in response to the health reforms, e.g.LHHNs and Medicare Locals

Health Workforce Leaders Group working with Health WorkforceAustralia

o The Health Workforce Leaders Group established through theHealth Skills Formation Strategy 2007-2010 continues to meettogether to explore and identify workforce strategies. This isa critical forum in the context of significant change occurringin the health industry as a result of the National Health andHospital Reforms

o In November 2011 the Health Workforce Leaders Grouphosted a workshop with over 40 people with the CEO of Health

Workforce Australia, Mark Cormack. Rod Camm, CEO ofSkills Queensland also attended this workshop. This workshopwas open to health industry stakeholders and provided an

opportunity to discuss the implementation of national strategies inQueensland.



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Outcomes for the group include:o Workforce Council has continued engaged with health industry leaders across all sectors

to support a whole of system approach to workforce planning across Queenslando Strong connections have been established with the National Health Workforce Agency,

Health Workforce Australia which will support future planning and implementation ofnational reform strategies within Queensland

o The mechanisms established including the Health Workforce Leaders Group will beaccessed by Health Workforce Australia to support their planning

Productivity Places Programo Workforce Council has brokered 160 Primary Health Care qualifications to Queensland

employers.

Ten Year Skilling and Workforce Development OutlookHealth industry will continue to grow rapidly over the next decade. The industry will continue toexperience significant skill and labour shortages, particularly in primary health care. This, in turnwill places increased pressure on the training and education sectors, and availability of clinicalplacements to support training will remain a potential blockage in developing the future healthworkforce.

New technologies and advances in health care will continue to create rapid changes in the natureand complexity of health services. The focus of priority will continue to move toward the communitysetting and on preventive and primary health services. Significant changes to the structure andfunding of key parts of the industry will have significant impact on the work roles and careerpathways.

Five Year Skilling Workforce Development Priorities Design training and development programs to enable new and changed roles and respond to

the multiple reforms in the industry. Develop industry led initiative which aims to identify the skill mix requirements

and consequent skill gaps Implement prolongation and participation programs for the ageing

workforce such as re-entry programs, refresher courses, occupationaltransition, knowledge management programs.

Explore more flexible models of delivery of education andtraining

Increase inter-disciplinary learning opportunities and horizontalintegration of curriculum



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Explore the capacity for e-learning and e-health in parallel with the roll out of the NationalBroadband Network.

Instigate contemporary learning models to better prepare a workforce for initiating innovation inthe emerging policy environment

Support the development of training capacity in the Aboriginal community controlled healthsector and linkages with RTOs.

Priorities for Action Over the Next Year Increase capacity of the sector to carry out workforce planning based on agreed scope of the

primary heath care sector Explore new models which provide for discipline-based workforce development in addition to the

more traditional professional based workforce development Increase the provision of training and development in workforce management of multi-

disciplinary teams in integrated service models of care Increase leadership and change management training and professional development to ensure

a capacity to prepare and manage a diverse and flexible workforce Increase provision of training and skills in areas expected to increase in demand into the future

including dementia care, counselling and community mental health. Develop strategies to increase skills in workforce management of multi-disciplinary teams

in integrated service models of care and complex service delivery across organisations andinstitutions.

Raise awareness of primary health careers to increase participation and retention of Aboriginaland Torres Strait Islander people in the primary health care workforce

Support the leadership capacity of the Aboriginal and Torres Strait Islander health workforce Create capacity to supply increased number of Aboriginal Health Workers to satisfy requirements

of the regulatory body

Increase the capacity of the education and training sector to deliver Certificate IV in Aboriginaland Torres Strait Islander Primary Health Care

Expand the scope of clinical training placements to maximize learning opportunities and futurecareer choices in the primary health care sector

Develop articulated training and career pathways for workers through improvedcollaboration across education systems

Greater use of skill sets to augment current qualifications. Support for regional clusters of service providers, education and training

providers and policy-makers to facilitate regional workforce planning,role design and regional training networks.

Improve industrys understanding of VET and industrys role ininfluencing the training system and the training they purchase. including strengthening collaboration stakeholders at the regionallevel.

Investigate the capacity of training providers in Queensland todeliver ATSI Primary Health Care qualifications to meet industrysneed. This assessment should include the availability of Aboriginaland/or Torres Strait Islander trainers and viability in the absence ofTIFIARRC.



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Health and Community ServicesWorkforce Council Inc.

Ground Floor, 303 Adelaide StreetBrisbane QLD 4000

Unit 1, Level 2 390 Flinders Street

Townsville QLD 4810

e. [email protected]

p.(07) 3234 0190f.(07) 3234 0474



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Documents

Wfc Industry Skills Report Primary Health Care 2012-09-24