Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

10.1 Challenges to growth in service delivery

Page last updated: 28 February 2012

Increased allocations have been made to both MSOAP and VOS, particularly in relation to outreach services for Aboriginal and Torres Strait Islander peoples. This section considers factors that may constrain the growth of these programs.

A core issue to consider is whether the existing workforce is willing to maintain or expand its participation in these programs, and whether the programs could be extended to other service providers. Some insights on these issues are available from the surveys of MSOAP service providers and VOS optometrists.

Service providers were asked how satisfied they were with the programs (Table 93). An estimated 87% of MSOAP service providers indicated they were very satisfied or satisfied, and 73% of VOS optometrists indicated they were very satisfied or satisfied. Four per cent of MSOAP service providers and 16% of VOS optometrists were dissatisfied.

Table 94 Satisfaction of service providers with MSOAP and VOS

Overall how satisfied are you with:
  MSOAP VOS
1. Very satisfied 38%

16%

2. Satisfied 49% 57%
3. Neither satisfied or dissatisfied 9% 11%
4. Dissatisfied 4% 16%

Source: HPA survey of MSOAP service providers and VOS service providers, 2011.



MSOAP service providers were asked whether they would be willing and had a capacity to expand service provision (Table 94). Thirty-one per cent indicated that they were not willing or had no capacity to expand the number of outreach visits, 32% indicated that could increase outreach visits by up to 10% and 37% indicated they could increase outreach visits by more than 10%. In qualitative responses common issues raised included ‘not enough time/availability to expand’, and ‘insufficient funding to support more visits/current visits not fully supported’.

Table 95 Capacity to expand outreach visits - MSOAP providers
Response category %
1. No 31%
2. Yes, number of visits could be expanded by up to 10% 32%
3. Yes, number of visits could be expanded by over 10% 37%

Source: HPA survey of MSOAP service providers and VOS service providers, 2011.



MSOAP and VOS service providers were also asked how long they intended to continue providing outreach services. Three per cent of MSOAP providers intended to continue outreach services for less than 12 months, 13% for one to two years, 22% for three to four years and 59% for five years or more (Table 95). This was impacted by the age of the service provider. Nineteen per cent of service providers were aged 60 years and over, and amongst this group, only 26% indicated they intended to continue outreach services for five or more years. In qualitative responses, issues mentioned that would influence a decision to continue included: age/retirement, family commitments, health problems, fatigue, funding decisions, levels of remuneration/high costs of service delivery.
Table 96 Age and intention to continue outreach services, MSOAP providersTop of page
  20-49 years 50-59 years 60 years and over Total
1. Less than 12 months 3% 2% 4% 3%
2. One to two years 13% 6% 26% 13%
3. Three to four years 16% 19% 45% 22%
4. Five years or more 65% 70% 26% 59%
Total excluding no response 100% 100% 100% 100%
Proportion in age group 43% 38% 19%  

Source: HPA survey of MSOAP service providers, 2011.



Eight per cent of VOS optometrists intended to continue outreach services for less than 12 months, 6% for one to two years, 8% for three to four years and 78% for five years or more (Table 96). An estimated 17% of VOS optometrists were 60 years and over.

Table 97 Age and intention to continue outreach services, VOS providers
  20-49 years 50-59 years 60 years and over Total
1. Less than 12 months 16%     8%
2. One to two years 5%   17% 6%
3. Three to four years 11%   17% 8%
4. Five years or more 68% 100% 67% 78%
Total excluding no response 100% 100% 100% 100%
Proportion in age group 56% 28% 17%  

Source: HPA survey of VOS service providers, 2011.



Based on these estimates, and assuming the workforce participating in MSOAP is approximately 1,000 specialists, an estimated 90 additional MSOAP participants will need to be recruited each year across Australia to replace those leaving the program. For VOS, around eight new optometrists would need to be recruited each year across Australia to replace those leaving the scheme.

Other potential constraints to the expansion of the programs include:
    • Space available in health services in remote communities in which to undertake outreach services.
    • Availability of required equipment in outreach locations.
    • Saturation of local primary health staff in managing outreach services along with primary care health demand.
    • As service provision levels increase, coordination issues become more difficult to manage without good systems and adequate resources specifically for coordination.
    • Additional coordination issues associated with the move towards team based care.
All of these issues are more problematic for more remote communities, where the needs are greatest and increased resources should be targeted.Top of page