Outcome 12: Health Workforce Capacity > Part 1 Outcome Performance Report

Major Achievements

• Supported clinical training in rural areas. Three new rural clinical schools were established in 2006–07, brining the number of schools to 14 across the country.
• Developed arrangements to implement, in conjunction with key professional and government stakeholders, a system to enable medical specialist training to be undertaken in a broader range of clinical settings.
• Helped enhance the quality of the workforce by contributing to the development of a national professions registration and accreditation scheme.
• Improved the distribution of the health workforce by modifying the Medical Workforce Distribution Programs to provide increased coverage in regional and outer metropolitan communities.

Challenges

• Delayed implementation of nationally consistent assessment processes for overseas trained doctors which was due in December 2006. Extensive negotiation with jurisdictions and stakeholders was required to implement a nationally consistent process which is now due to be implemented from July 2007.
• Lower than expected uptake of the More Doctors for Outer Metropolitan Initiative Relocation Incentive Grant Program early in 2006–07.

Key Strategic Directions for 2006–07

Implementation of Reforms under the Council of Australian Governments Health Workforce Package

During 2006–07, the Department implemented key health workforce reforms aimed at increasing the capacity of the health workforce into the future. The reforms are part of the Government’s contribution to the Council of Australian Governments (COAG) Health Workforce package and focus on improving the overall capacity of the health system. They also aim to improve the coverage and quality of training arrangements and enhance workforce practice, flexibility and quality. Two of the key COAG decisions for which the Department has had major input or carriage relate to the national registration and accreditation of health professions and the expansion of medical specialist training into a broader range of settings.

National Registration and Accreditation of Health Professionals

The Department played a substantial role in the development of the final model for the national registration and accreditation scheme for nine health professions which was announced by COAG in April 2007. The scheme will cover nursing and midwifery, medicine, pharmacy, physiotherapy, psychology, dental care, optometry, osteopathy, and chiropractors. The Department achieved this through collaborative arrangements with the states and territories, by providing comprehensive policy advice,liaising with the professions and developing options for the consideration of Health Ministers. Health Ministers will be responsible for the implementation of the scheme and the Department will be involved in developing its policy, procedural and operational aspects. COAG agreed that the scheme will be operational by 1 July 2008.

Expansion of Medical Specialist Training

In 2006, the Department began work on the development of the Government’s ExpandedSettings for Specialist Training Program following the COAG decision that medical specialist training be conducted in a wider range of settings, in line with contemporary specialist medical practice. On 26 October 2006, the Australian Health Ministers’ Advisory Council noted the final report of its Medical Specialist Training Steering Committee, which was tasked with investigating issues in implementing arrangements for medical specialists to undertake training in a broader range of settings. The Department provided secretariat support for the Steering Committee. In November 2006, the Australian Health Ministers’ Conference agreed that the report be drawn upon in the implementation of COAG’s decision.

During 2006–07, the Department progressed this work in consultation with key stakeholders, including professional bodies, health provider representative bodies and State and Territory governments. This included the establishment of a national non-statutory committee, the Enhanced Medical Education Advisory Committee, to provide advice on the ongoing development and implementation of the expanded specialist training arrangements, which are to be in place by January 2008. By June 2007, more than 60 facilities had indicated their interest in participating in the new arrangements, with negotiations underway to have additional training places accredited and agreed with stakeholders by January 2008. Further, by 30 June 2007, initial agreement was reached in establishing 26 new specialist training posts across a range of private and community settings in metropolitan and regional Australia. Ten pathology training posts have been agreed to commence in July 2007 and a further 16 by January 2008, subject to specialist college accreditation arrangements and agreement with the relevant jurisdictions.

Delivery of Health Workforce Distribution Programs

The Department continued to support a broad range of programs during the year to improve the distribution of Australia’s health workforce. This involved providing ongoing funding to the Nurse Scholarship Program, the Rural Allied Health Undergraduate Scheme and the Australian Rural and Remote Health Professional Scheme. This latter initiative provided students, practising nurses or allied health professionals with financial assistance to undertake undergraduate or postgraduate study, attend conferences, update skills and qualifications or re-enter the nursing workforce. All three programs continued to be very popular with high ongoing interest within the rural and remote communities of Australia. This year 110 undergraduate nursing and 65 undergraduate allied health scholarships were awarded.

In addition, the proportion of Government-supported medical school places that are bonded under the Bonded Medical Places Scheme increased to 25 per cent of all students commencing studies from 1 January 2007 and each annual intake thereafter. Currently there are a total of 1,260 medical students participating in the scheme, of which 535 commenced their medical studies in 2007. Bonded Medical Places Scheme participants are required to work in Districts of Workforce Shortage in outer metropolitan, rural or remote areas for six continuous years on successful completion of their fellowship training. Under the Medical Rural Bonded Scholarship Scheme the allocation of 100 first year medical school places continued to be fully subscribed. Currently there are 700 participants in the scheme. Medical Rural Bonded Scholarship participants are bonded to work in rural and remote areas of Australia for six continuous years on completion of successful fellowship training in a speciality.

Rural Training Facilities

The Department also continued to support the national network of rural training facilities established under the Rural Clinical Schools and University Departments of Rural Health initiatives. Three new rural clinical schools were established in 2006–07, bringing the number of schools to 14 across the country, operated by 12 different universities. In 2006, over 380 students completed extended rural placements at rural clinical schools. In the same period over 3,355 students in a variety of health science disciplines undertook short term placements at University Departments of Rural Health. Training activity for both programs was supported by combined infrastructure expenditure in excess of $11.2 million. Rural communities benefited from these initiatives through enhanced recruitment and retention of their health workforce as well as through the economic activity generated by these growing health education facilities.

Relocation of Doctors and Specialists to Outer Metropolitan Areas

The More Doctors for Outer Metropolitan Areas Initiative aims to attract up to 265 general practitioners and specialists and up to 50 specialist training placements to meet ongoing needs in these areas over four years from 2006–07. Lower than expected uptake early in 2006–07 led to the commissioning of market research to better understand the recruitment experience of outer metropolitan General Practice practises and to boost marketing of the grant. As a result, in 2006–07 more than 100 doctors and specialists agreed to relocate to outer metropolitan areas under the More Doctors for Outer Metropolitan Areas Initiative Relocation Incentive Grant Program. Increased promotion of the grant by the Department contributed to achieving this target.

Recruitment and Distribution of Overseas Trained Doctors

The number of overseas trained doctors and specialists working in Australia continued to increase in 2006–07 with an additional 140 doctors, 114 general practitioners and 26 specialists being recruited and commencing work in rural, remote and other areas of workforce shortage.

The recruitment of overseas trained doctors was supported by a range of initiatives managed by the Department which were aimed at simplifying processes for entering and working in Australia and improving training and support arrangements. This included providing upskilling program funding to state and territory health departments and medical colleges to provide support and training to overseas trained specialists to achieve fellowship of the relevant specialist medical college.

Following the announcement at the July 2006 meeting of COAG, a national assessment process for overseas trained doctors is being phased in from July 2007. The Department strongly supports the new process and is working with all states and territories to ensure that overseas trained doctors, regardless of where they work, meet a set standard of knowledge and skills before they are allowed to begin seeing patients. Due to the extensive negotiation that was required with jurisdictions and stakeholders, the implementation of the nationally consistent process was delayed from December 2006 to July 2007.

A key measure for the distribution of overseas trained doctors to areas of workforce shortage was the Medicare provider number restrictions under Section 19AB of the Health Insurance Act 1973. The number of applications by overseas trained doctors seeking to access the Medicare benefits arrangements continued to increase with the Department implementing a number of changes to the administration of the measure to enhance its responsiveness and effectiveness. There are currently around 3,920 overseas trained doctors accessing the Medicare benefits arrangements of which approximately 67 per cent are general practitioners and 33 per cent are specialists.

Improved Indigenous Health Workforce Capacity

The Department worked with the Medical Deans of Australia and New Zealand (formerly the Committee of Deans of Australian Medical Schools) to incorporate Indigenous curriculum content in all medical courses. This will help to ensure the medical workforce is more responsive and provides culturally appropriate care in order to meet Aboriginal and Torres Strait Islander health needs. Another key initiative was the development of new national qualifications for Aboriginal Health Workers and Torres Strait Islander Health Workers as part of the Health Training Package within the Vocational Education and Training Sector.

The Department continued to support Aboriginal and Torres Strait Islander health workforce representation and development through the provision of funding to the Congress of Aboriginal and Torres Strait Islander Nurses and the Australian Indigenous Doctors Association. The Congress and the Association provide advice to the Government and other stakeholders on strategic policy and program development. They also advise on implementation issues that relate to Aboriginal and Torres Strait Islander nurses and doctors and impact more broadly on health outcomes for Aboriginal and Torres Strait Islander people. Both organisations collaborate with the education and employment sectors to develop and implement culturally appropriate strategies that focus on the recruitment, retention and support of Aboriginal and Torres Strait Islander nursing and medical students.