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

5.1 Program origins and development

Page last updated: 28 February 2012

The Medical Specialist Outreach Program (MSOAP) was established in 2000 by the Commonwealth Government to increase access to specialist services in rural and remote regions of Australia. The original objectives of the program have not changed over time. They include:

    • Increasing visiting specialist services in areas of identified need.
    • Supporting medical specialists to provide outreach medical services in rural and remote areas.
    • Facilitating visiting specialist and local health professional communication about ongoing patient care.
    • Increasing and maintaining the skills of regional, rural and remote health professionals in accordance with local need.
(DoHA Department of Health and Ageing 2010a)

The program was originally designed to expand on existing outreach services, some of which were supported by state and territory governments. Originally existing outreach services were ineligible for support under the program. A change in policy was made around 2004, allowing specialists providing outreach services prior to 2000 to receive support. However, an ongoing issue has been whether state and territory governments are maintaining their efforts in relation to specialist outreach services. To some extent this issue is also intertwined with the extent to which the program should support outreach services relative to admitted patient hospital care.
The program is largely managed by fundholders located in each state and the Northern Territory under funding agreements with DoHA. The range of functions managed by fundholders are described in detail below.

Since the establishment of MSOAP in 2000, there have been three expansions made to the program, including Indigenous Chronic Disease (MSOAP-ICD) in 2009-10, Maternity Services (MSOAP-MS) and Ophthalmology (MSOAP-Ophth) in 2011-12. The expansions of the program provides targeted support in specific areas of need, and also brings GPs, nurses and allied health practitioners within the scope of the program.

MSOAP-ICD is funded under the Indigenous Chronic Disease component of the COAG Closing The Gap Initiative. Its objectives are to:
    • Support health professionals to provide outreach services to rural and remote Indigenous communities.
    • Increase the range of services offered by visiting health professionals to treat and manage chronic disease more effectively.
    • Foster the collaboration between local Indigenous health services and visiting health professionals to target the delivery of essential treatment to patients with chronic disease.
    • Improve ongoing management and continuity of patient care.
    • Provide upskilling opportunities for local health professionals.
    • Work with communities to build knowledge and support informed self-care.
MSOAP-MS is an expansion of MSOAP that increases access in rural and remote regions to maternity services for women and their families. The services provided through this program cover pregnancy, confinement and post natal stages. The program has been commenced in 2011, with a target of 59 services by 30 June, 2011. Funding for the program was set at approximately $16 million over four years.

MSOAP-Ophth provides increased ophthalmology services to inner regional to remote locations in Australia from 1 July 2010. Funding for the Program is $5 million over four years, with $824,000 over four years allocated to the Australian Society of Ophthalmology (ASO) to assist in assessing need and recruiting ophthalmologists to support this expansion.

As well as the general arrangements with MSOAP fundholders, the program has included several specific arrangements, some of which involve funding allocated to other organisations. These include:
    • A Paediatric Surgery Outreach Program (PSOP) originally managed by the Royal Australian College of Surgeons providing outreach paediatric surgery services to selected communities in New South Wales and Victoria. This arrangement was subsequently transferred to the Rural Workforce Agency Victoria (RWAV), the MSOAP fundholder for Victoria, although it still involves New South Wales outreach services.
    • In Western Australia, an annual grant is made to the Western Australia Country Health Services (WACHS) to support the Kimberley Paediatric Outreach Program (KPOP). KPOP supports two paediatricians and one paediatric trainee to deliver specialist outreach services and professional upskilling to communities in the Kimberley region.
    • Australian College of Rural and Remote Medicine (ACRRM), which is funded for the Tele-Derm (telemedicine to provide dermatology consultations) initiative.
    • Baker IDI Heart and Diabetes Institute in Melbourne is funded under MSOAP-ICD to provide diabetes prevention and management services, specifically for the communities of and around Alice Springs in the Northern Territory over three years to June 2012.
    • The Anangu Pitjantjatjara Yankunytjatjara (APY) lands receive funding over four years from 2009-10 for a multidisciplinary team to provide services to the APY lands. Funding is managed through MSOAP but is sourced from an OATSIH program.
The Urban Specialist Outreach Program (USOAP) is a related program through which outreach services for Aboriginal and Torres Strait Islander people in urban settings can be supported. USOAP is currently operational in four states. It operates on a similar basis to MSOAP and is administered by MSOAP fundholders in the four states in which it currently operates.

Table 29 – MSOAP program expenditure 2000-01 to 2010-11 and budget allocations 2011-12

Program

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

 

$m

$m

$m

$m

$m

$m

$m

$m

$m

$m

$m

$m

MSOAP Core

3.5

8.2

12.4

12.5

14.6

15.5

18.2

16.2

19.2

19.4

19.7

19.7

MSOAP-ICD

 

 

 

 

 

 

 

 

 

1.4

7.8

19.5

MSOAP Ophthal.

 

 

 

 

 

 

 

 

 

 

0.1

0.2

MSOAP Maternity

 

 

 

 

 

 

 

 

 

 

 

3.4

Total

3.5

8.2

12.4

12.5

14.6

15.5

18.2

16.2

19.2

20.1

27.6

42.8


Source: Program data provided by DoHA (2005-06 to 2011-12); Morey Australia 2003 p 61 (2000-01 to 2003-04 – Note there were significant under spends in 2000-01 and 2002-03).


Eligibility criteria vary between the MSOAP programs. The key differences relate to the locations eligible and targeted under the programs and the types of outreach services that can be supported.

Location: Under MSOAP Core, eligible outreach services are those to locations in the ARIA regions of accessible, moderately accessible, remote, and very remote. The areas of need are decided by the relevant advisory fora and ARIA is used as guide. In some cases services to Highly Accessible regions will be considered. The eligibility criteria are switching to ASCG Remoteness Areas RA2-RA5 from July 2011.

For MSOAP-ICD, eligible outreach services are those to locations in ASGC remoteness areas RA2 - RA5. The guidelines indicate the program should be focused on Aboriginal and Torres Strait Islander communities situated in remote (RA4) and very remote (RA5) locations and communities with a majority Aboriginal and Torres Strait Islander population and communities with a high rate of chronic disease.

For MSOAP Ophthalmology, eligible outreach services are those to locations in ASGC-RA2 - RA5. No other focus or target is specified in the guidelines.

Eligible services: Under MSOAP Core, support is provided for medical specialists providing outreach services. Costs of travel (not salary) for registrars and technical staff assisting specialists with procedures (excluding nursing or allied health personnel) may be covered on a case by case basis.

MSOAP-ICD extends eligibility to multidisciplinary teams which may include medical specialists, GPs and allied health professionals including nurses and Aboriginal health workers. A multidisciplinary team approach is encouraged. Sometimes case managers and coordinator functions are included in proposals. Costs of travel (not salary) for registrars and technical staff assisting specialists with procedures may be covered on a case by case basis. Extensions to existing services and establishment of new services are supported. MSOAP-ICD will only support services related to chronic diseases defined as diabetes, cardiovascular disease, chronic respiratory disease, chronic renal disease and/or cancer. Services supported can relate to prevention, detection or management.

Under MSOAP Maternity Services, multidisciplinary teams are eligible including midwives, medical specialists, GPs including Procedural GPs, Aboriginal health workers and allied health. Costs of travel (not salary) for registrars and technical staff assisting specialists with procedures may be covered on a case by case basis. Extensions to existing services and establishment of new services are supported.

Cultural Training and Orientation: Under MSOAP Core cultural training and orientation may be required, but not for all outreach services. Only non-salaried private specialists can be supported for these activities. Cultural training and orientation are a requirement for all service providers under both MSOAP-ICD and MSOAP Maternity. Top of page