Review of Australian Government Health Workforce Programs

Review recommendations 208

Page last updated: 24 May 2013

Ensuring a capable and qualified health workforce

Footnote: 208 Major recommendations are shaded.

Quality framework for the health workforce
Recommendation numberRecommendationAffected programsTimeframe
Recommendation 3.1 (shaded)The Commonwealth via the Standing Council on Health (SCoH) should engage with the national health professional boards to develop sensible and more consistent requirements for continuing professional development, recency of practice and re-entry to practice. Ideally, this should be undertaken for all registered professions and focus on maximising access to health services while maintaining safety and quality for the community. Professional re-entry requirements in particular, should be subject to periodic review for unduly onerous requirements creating barriers, particularly for regional workforce. NilMedium term
Recommendation 3.2 (shaded)The Commonwealth should seek that SCoH bring forward options for a common legislative framework for prescribing of medicines by non-medical health professionals to promote workforce productivity, flexibility and mobility. NilMedium term
Recommendation 3.3The Commonwealth should identify and address any possible barriers to unregulated professions participating in Australian Government programs, where appropriate.Allied health programs and scholarships.Short term
Health education and training
Recommendation numberRecommendationAffected programsTimeframe
Recommendation 3.4 (shaded)The Commonwealth should continue to invest in clinical training initiatives to help ensure the future health workforce has the right training to meet community needs. This should include ongoing investments in the clinical aspects of undergraduate health education across disciplines, as well as targeted funding for vocational medical training. There are pressures on training capacity and it is critical that government investment is cost-effective and sufficiently flexible to allow resources to be directed towards identified priority areas. HWA, AGPT, STP, PGPPP, RHMTShort term –ongoing.
Recommendation 3.5 (shaded)A new focus on collaboration between organisations involved in health education programs needs to be mandated as part of core program delivery. Specific requirements should be incorporated into funding arrangements, with effective collaboration included as a key performance indicator for each initiative. AGPT, STP, RHMT (inc RCTS, JFPP, UDRH and DTERP) PGPPP, RVTSMedium term – as agreements expire.
Recommendation 3.6 (shaded)The Commonwealth (as well as Health Workforce Australia (HWA)) should engage more closely with the private health sector in developing and implementing health education training initiatives. This engagement should be planned and regular and occur at a senior level. This approach should help to enhance the potential for private sector training capacity to be utilised more fully and in a more structured and consistent way.DoHA and HWA Health education programs.Short term and ongoing – to commence post-Review.
Recommendation 3.7 (shaded)The Commonwealth, in close consultation with General Practice Education and Training Limited (GPET) and other key stakeholders, should investigate reforms to the way in which support for intern training placements is delivered in general practice and community settings. While maintaining the focus on intern training in primary care is crucial, there may be an opportunity to work with GPET to invest a portion of the funds currently dedicated to the Prevocational General Practice Placements Program (PGPPP) in new models discussed in this review.PGPPPMedium term
Recommendation 3.8Reforms to the Commonwealth’s investment in junior doctor training will need to be targeted towards building a more integrated training pathway for new graduates, with a proportionate emphasis on rural training. This pathway should continue to provide structured opportunities for junior medical officers to experience general practice.PGPPPMedium term
Recommendation 3.9The Specialist Training Program (STP) should provide indexed funding for its training posts. STP, Specialist training component of the More Doctors and Nurses for Emergency Departments program. Short term – indexation to commence as agreements with specialist colleges are extended.
Recommendation 3.10While STP has been a well received and apparently successful program, it is important that a full evaluation of the program should be carried out to verify that settings such as the mix of positions are optimal, and to inform the future development of the scheme.
In addition, existing STP posts should be reviewed by colleges (in discussion with the Department and other program stakeholders) to ensure they are meeting the objectives of the program. This may provide the opportunity to redirect funds to new training posts that may better meet emerging workforce priorities.
STP, Specialist training component of the More Doctors and Nurses for Emergency Departments programShort term – review to commence by the end of 2013.

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Health education scholarships
Recommendation numberRecommendationAffected programsTimeframe
Recommendation 3.11 (shaded)This review has identified inconsistencies in scholarship funding arrangements (in both administration costs and levels of support to recipients) that need to be rectified to ensure equity and value for money. To progress this issue, If the recommendations of this review are accepted, a detailed mapping of each of the health workforce scholarship schemes across the Department will have to be undertaken. This process should include an analysis of:
  • the administrative costs of existing scholarship activities with a view towards establishing clear benchmarks for application across programs; and
  • the financial and other value of various scholarships for both appropriateness and consistency across the various activities funded.
All scholarships including PHMSS, MRBS, NAHSS, RAMUS, SARRAH scholarships, Aged Care scholarships, Pharmacy scholarships.Short term – review to commence from July 2013.
Recommendation 3.12The Commonwealth should develop a health workforce scholarship internet portal. This should be the main source of information on scholarships funded by the department. It should have directions and links to other pages managed by scholarship administering agencies.All scholarshipsShort term – development to commence as soon as possible.
Recommendation 3.13The Commonwealth needs to develop measurable health workforce objectives for all scholarship schemes and embed agreed outcomes in contracting, program reporting and post-project evaluation. All scholarshipsMedium term – embed outcomes reporting measures in agreements with program management agencies as they expire.
Recommendation 3.14Detailed workforce data analysis needs to be undertaken to determine where scholarship funding may be most efficiently targeted to achieve workforce distribution objectives in future funding rounds. Such analysis needs to include evidence about the effectiveness of financial support for students suffering other disadvantage in choosing to enter and remain in training for particular health professions.All scholarshipsLonger term – informed by better outcomes data and analysis outlined in recommendations above.
Recommendation 3.15 (shaded)As part of the further evaluation work recommended above, the Commonwealth should specifically consider whether continued investment in the Medical Rural Bonded Scholarship (MRBS) Scheme represents value for money in terms of the level of the scholarship in comparison to other programs, and the workforce outcomes desired.
Subject to more detailed data becoming available, this review recommends phasing out new scholarship funding and converting MRBS medical school places to standard Commonwealth funding places.
Scholarship commitments and return of service requirements for existing participants would be maintained under this scenario with the possible option of allowing some flexibility for students to buy their way out of the commitment.
Any funding released from the reconfiguration of MRBS should be redirected towards the Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme and to the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) rural scholarships for allied health students.
Given current funding levels, over time this change should substantially increase the number of scholarships that are awarded to support rural workforce outcomes. It would also allow funding to be redirected towards rural students with demonstrated financial need, and allow a greater proportion of funds to be provided to nursing and allied health than is currently the case.
MRBS, RAMUS, NAHSSSMedium to long term.
The award of new MRBS places could be ceased from 2014 and funding could begin to be redirected to other priorities. Existing scholarship commitments will need to be honoured for up to six years, depending on the length of degree of individual participants.
Recommendation 3.16 (shaded)The Commonwealth should undertake further policy analysis of possible models for consolidation of health workforce scholarship schemes within professional groups. The aim should be to reduce administrative costs and streamline reporting arrangements to maximise the number of scholarships available to each health profession. All scholarshipsLonger term
Recommendation 3.17 (shaded)The Commonwealth should consider changing the focus of its nursing scholarship funding towards postgraduate scholarships that are responsive to identified nursing workforce retention needs, informed through HWA workforce data and analysis. In the first instance the priorities should be mental health, aged care and palliative care. This would provide the ability to target those areas identified and would ensure that priority was given to students undertaking studies in nursing courses or specialties identified in the HWA data. Financial need should also be a relevant consideration.NAHSS, Aged Care Nursing Scholarships.Medium term – implementation to commence from the 2014 allocation of new scholarships.
Recommendation 3.18As part of any implementation of recommendation 3.15, listed above, the Commonwealth should explicitly consider increasing the number of allied health scholarship and support places with a priority given to rural training locations. Allied health scholarships, such as those managed by SARRAH.Longer term – subject to available funding.

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Addressing health workforce shortages in regional, rural and remote Australia

Health education strategies for rural distribution
Recommendation number Recommendation Affected programs Timeframe
Recommendation 4.1 (shaded) The Commonwealth should take leadership in developing a new, more integrated rural training pathway, linking its investment in rural undergraduate medical training with new support for rural intern places and continued growth in specialist training positions. The model will need to build on existing programs and maintain access to primary care and private sector training though the development of a more networked approach to delivering quality education. This may need to involve some re-profiling of existing investments. It will need to be delivered through a highly collaborative approach involving consortia of key training/accreditation bodies and health service providers. All available policy levers, including contracting and reporting mechanisms, should be directed at incentivising collaboration by local and regional agencies and supporting a local network approach. AGPT, STP, RCTS PGPPP, HWA clinical training funding. Medium term – timeframes will be subject to reform of funding arrangements and engagement with stakeholders around new educational models.
Recommendation 4.2 (shaded) The Commonwealth should consider opportunities for extending the approach to building rural training pathways in the allied health, dentistry and nursing disciplines. This will need to retain the core principles of providing a more seamless transition from undergraduate training into rural practice or further professional rural training for students in these disciplines. However, it will be important to note the different structure of postgraduate training in medicine compared to other disciplines. New funding activity Medium term – subject to available funds.
Recommendation 4.3 (shaded) The Commonwealth should seek that the Standing Council on Health engage with the national health professional boards and their accrediting agencies to encourage development of intra- and inter-profession courses that enable health practitioners to provide a broader range of services in rural areas. Nil Medium term
Recommendation 4.4 Commonwealth support to extend rural training at medical schools to cover full degree programs could generate positive outcomes. Current workforce projection data, including the findings of Health Workforce 2025, suggests that the distribution of new graduates needs to be the priority rather than increasing overall graduate numbers. Current proposals in this area should continue to be explored with careful analysis of the costs and benefits of the different models. RCTS, NT Medical Program. Longer term – any extension of existing rural medical programs will be subject to funding availability and the development of comprehensive costing models.
Recommendation 4.5 The Rural Clinical Training and Support (RCTS) program should expand its focus on supporting multidisciplinary training placements. This activity is already included within the program parameters but needs to be pursued more vigorously, where funding is available. Consideration should be given to RCTS infrastructure needs to support a multidisciplinary approach. RCTS Medium term – RCTS activities could begin to expand in this area from 2014.
Recommendation 4.6 (shaded) The mandatory four week rural placements required for all medical students under the RCTS program should be abolished, in favour of increased support for longer-term high quality elective placements which are currently generating good outcomes. Funds released from supporting short-term placements should be redirected towards other priorities within the RCTS initiative. This should include enabling training sites to play an enhanced role in developing integrated vocational training pathways. This would be achieved through supporting new academic positions to play a key role in developing networked training partnerships. RCTS Medium term – current placement arrangements could be reformed from the start of 2014, in consultation with medical schools.
Recommendation 4.7 The advantages of extending the current RCTS program rural medical student enrolment target approach to other health disciplines should be examined. The target level and the likely implementation cost across the health disciplines would need to be determined, including the resources required by universities to achieve agreed goals. RCTS Longer term – funding implications and the ability of other health disciplines to achieve this type of target are more complex issues.
Recommendation 4.8 There is strong potential for the network of 11 University Departments of Rural Health (UDRHs) to play a greater role in supporting longer term, more structured, rural training placements for allied health, dental and nursing students. This should be supported by the Commonwealth where funding is available. The service learning model put in place by the Broken Hill UDRH should be explored further, including the cost implications of this model across the UDRH network. UDRH Medium term – expansion of UDRH training is subject to funding availability. New activities would need to be progressed during the next funding period.
Recommendation 4.9 Any extension of a comprehensive rural training program to cover nursing, allied health and dentistry should be supported by the collection of longitudinal outcomes reporting. The value of adopting a similar approach to the Medical Schools Outcomes Database project, and linking this to national registration data, should be considered. UDRH and allied health clinical training support programs (SARRAH/ NAHSSS) Longer term – reflecting long lead times for the development of data systems.
Recommendation 4.10 Research activities funded under the core operational grants of the RCTS and UDRH programs need to be examined in consultation with key program stakeholders to ensure they are effective and well-targeted. The Commonwealth should encourage greater rural research collaboration and seek to reach agreement across the UDRH network on an appropriate maximum research proportion of the program’s core operational grant. This process could build on the work of the Research Leaders Network that has been established through Australian Rural Health Education Network (ARHEN). RCTS, UDRH Medium term – a new research strategy will require extensive development work and consultation.
Recommendation 4.11 There could be benefit for the Commonwealth and for universities in pursuing further consolidation of the RCTS and UDRH programs. This should be pursued on a case-by-case basis, taking into account the willingness of individual universities to pursue integration and administrative efficiencies. This approach will have benefits for some organisations but may not be appropriate in all cases. RCTS, UDRH Medium term – case-by-case consolidation could begin to occur as existing funding agreements expire.
Recommendation 4.12 Rural health clubs should extend their focus to maintaining the involvement of graduates as they progress into further training beyond university. Expanded activities in this area may require additional funding support. RHMT Medium term – subject to available funding.

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Rural recruitment and retention strategies
Recommendation number Recommendation Affected programs Timeframe
Recommendation 4.13 (shaded) Continued support for rural doctors, including targeted financial incentives, should remain a key component of the Government’s health workforce strategy to address the serious ongoing maldistribution of health professionals. However, there is currently insufficient emphasis on support for other health professionals. A broader approach to rural health workforce development, focussing on social and professional issues as well as financing, needs to be taken consistently to complement the Government’s current investments. GPRIP, HECS Reimbursement Ongoing, with longer term development of new approaches, as outlined below.
Recommendation 4.14 (shaded) Expenditure on the General Practice Rural Incentives Program (GPRIP) needs to be better targeted for equitable workforce outcomes by: Adopting a modified rural classification system and better targeting financial incentives towards smaller regional settings in Australian Standard Geographic Classification – Remoteness Areas (ASGC-RA) RA2 and 3, while maintaining expenditure in RA4 and 5; and Designing and implementing a new capped, decentralised incentive approach delivered through regionally based workforce development agencies such as Medicare Locals and Rural Workforce Agencies. Movement to a regionally based approach in the medium to longer term is strongly preferable as it offers both fiscal certainty and the opportunity to enhance outcomes. Determining need at the local and regional level is likely to be more effective than the current centralised entitlement system. This approach also provides flexibility to direct resources to the recruitment and retention of other professional groups, subject to local workforce requirements and identified health needs. GPRIP Medium term – new models of financial support will require extensive consultations with stakeholders and the development of revised administrative systems.
Recommendation 4.15 Any change to a new incentive system should feature an appropriate transition period, of at least one financial year, and further consultation with stakeholders about the detailed requirements and funding allocation systems. Arrangements for supporting rurally based GP registrars should be considered as part of this process. GPRIP Medium term
Recommendation 4.16 (shaded) The HECS Reimbursement Scheme should be integrated with the similar HECS-HELP forgiveness initiative already managed by Department of Industry, Innovation, Climate Change, Science, Research and Tertiary Education (DIICCSRTE) and the Australian Taxation Office (ATO). While the latter scheme already covers nurses, the benefits and costs of participation by rural allied health professionals should also be examined. Integration should achieve administrative savings and an ability to target HECS forgiveness in a responsive manner to projected workforce shortages. HECS Reimbursement Medium term
Recommendation 4.17 The Rural Health Continuing Education (RHCE) program (Stream 2) provides a good basis for supporting postgraduate training in allied health and nursing, but is significantly oversubscribed. The Commonwealth should consider expanding this program and linking it to other training initiatives, subject to the availability of further funding. RHCE Longer term – expansion will be subject to funding availability.
Recommendation 4.18 (shaded) The Commonwealth should progress the consolidation of the administration of the various discipline-based locum programs into an integrated rural multidisciplinary locum provision service. SOLS, GPALS, Rural LEAP, NAHRLS Medium term – consolidation should be pursued as existing funding agreements expire.
Recommendation 4.19 Government involvement in alternative rural health service models should continue to be explored. Investments in developing new practice models in areas of market failure may assist to ensure more remote communities can access reasonable levels of service. Primary and Ambulatory Care Division programs, new workforce initiatives. Longer term – new models require significant development for national implementation, subject to available funding.
Reform of the ASGC-RA rural classification system
Recommendation number Recommendation Affected programs Timeframe
Recommendation 4.20 (shaded) The ASGC-RA system should be substantially adapted to the needs of health workforce programs to more appropriately recognise differing access to health services within broad geographic regions and within communities. A modification to the “Monash model” is recommended as the approach most likely to provide positive enhancements to current systems. This “modified Monash model” would retain the ability to provide greater definition between locations in the same ASGC-RA bands (RA2 and 3) while recognising the need to allow for remoteness as a key factor (retaining RA4 and 5). The geographic classification components of the revised system should be based on the Australian Statistical Geography Standard (ASGS), as the ABS will soon replace the use of ASGC with this enhanced system. Further work on the implementation of this model will be required before it can be used within individual programs. The model is not appropriate for application inflexibly across programs. Each initiative may need to adjust its guidelines to use the revised system in the most effective way. The Department should commence discussions with stakeholders on a revised model based on the core principles outlined in the Report. This should include discussions across the portfolio around the implications for other program areas and the potential for broader application of the model outside workforce initiatives. An implementation working group should be established. GPRIP and other incentive programs, rural training programs Short term – further development of the classification model and data systems will be required immediately following this review. Medium term – health workforce programs, and potentially other Commonwealth initiatives, will need to transition to the enhanced system.

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Supporting the Aboriginal and Torres Strait Islander health workforce

Supporting the Aboriginal and Torres Strait Islander health workforce
Recommendation Recommendation Affected programs Timeframe
Recommendation 5.1 There must be better coordination of activities aimed at increasing the capacity of the Aboriginal and Torres Strait Islander health workforce, across the Department of Health and Ageing and across other Commonwealth agencies working in this area including Health Workforce Australia, the Department of Families, Housing, Community Services and Indigenous Affairs, the Department of Education, Employment and Workplace Relations and the Department of Industry, Innovation, Climate Change, Science, Research and Tertiary Education. This should include the formulation of clear implementation plans, timelines and reporting processes to avoid the current potential for policy stalemates. All Aboriginal and Torres Strait Islander health workforce programs Short term – enhanced coordination should commence as soon as possible.
Recommendation 5.2 (shaded) The Commonwealth should continue to fund peak Aboriginal and Torres Strait Islander bodies/networks (under the Training Package) to help drive progress in Aboriginal and Torres Strait Islander health education and training for both health students and the health workforce. Aboriginal and Torres Strait Islander Health Workforce Training Package Short term – ongoing.
Recommendation 5.3 (shaded) The Commonwealth should continue to consult with the National Congress of Australia’s First People’s National Health Leadership Forum, as the collective and consultative forum of peak Aboriginal and Torres Strait Islander health workforce bodies. This forum should continue to assist in collaboration and coordination within and between these organisations. The Commonwealth should also ensure that it continues to work closely with the National Health Leadership Forum on the ongoing implementation of strategies arising from community consultations and the recommendations of this review of health workforce programs. Engagement between the National Health Leadership Forum and cross-jurisdictional consultative groups such as the Health Workforce Principal Committee should also be considered in this context. Complementary consultative arrangements, through a regular working group similar to those of the Coalition of National Nursing Organisations, may be beneficial in achieving implementation of identified strategies. Discussions between HWD and OATSIH on consultation activities. Medium term – allowing appropriate time for consultation with key groups.
Recommendation 5.4 The Commonwealth should build on the success of the Leaders in Indigenous Medical Education (LIME) Network by extending its reach or reconfiguring this group to include support and mentoring for all Aboriginal and Torres Strait Islander tertiary level health professional students, including nurses and midwives, dentists and allied health professions. Alternatively, activities of the LIME network could be adopted by other networks in their specified health discipline. Aboriginal and Torres Strait Islander Health Workforce Training Package Short term
Recommendation 5.5 (shaded) The Commonwealth should develop and implement a new national program specifically aimed at: increasing Aboriginal and Torres Strait Islander health student enrolment and graduate numbers; and pursuing the development and inclusion of culturally appropriate curriculum into all health courses. Alternatively, there may be an opportunity to extend the existing workforce and support component of the Indigenous Chronic Disease Package to achieve the above aims. Possible mechanisms to achieve the program outcomes should be further explored including options for delivery such as virtual support and/or support units with physical office locations. Extending the Aboriginal and Torres Strait Islander support units which are currently in place in various universities should be considered rather than duplicating current efforts. Support units will need to vary from location to location, taking into account the service delivery environment and, where appropriate, encouraging collaborative regional support hubs. These regional support hubs should incorporate partnerships between universities. The program should extend to all tertiary health professional courses (as opposed to medicine only). Program targets should have key performance indicators, such as the percentage of students entering or graduating that are of Aboriginal and Torres Strait Islander background relative to the Aboriginal and Torres Strait Islander population at either a national or geographic regional level. Partial funding for this Aboriginal and Torres Strait Islander health program could be redirected from the current Rural Clinical Training and Support (RCTS) program. Indigenous Chronic Disease Package RCTS program Funding source to be identified through cross-portfolio discussions. Medium term – this reform and extension of the current RCTS targets should be considered when existing agreements with universities expire. Additional funding beyond the RCTS program is likely to be necessary to achieve a sustainable investment across health disciplines. Longer term – subject to the availability of funding and engagement with both Aboriginal and Torres Strait Islander groups and the university sector.
Recommendation 5.6 (shaded) Recommendation 5.5 should be complemented by the development of Aboriginal and Torres Strait Islander academic leaders/champions and Aboriginal and Torres Strait Islander student support networks that would provide culturally appropriate mentoring, counselling and, if appropriate, pastoral care type activities to all Aboriginal and Torres Strait Islander health students. This may also include providing support to students’ direct family members, which may assist the student to remain in study and graduate. This could be achieved by further developing the “Health Heroes” (part of the Indigenous Chronic Disease Package). Funding source to be identified through DoHA and cross-portfolio discussions. “Health Heroes” (Indigenous Chronic Disease Package). Longer term – as above.
Recommendation 5.7 The Commonwealth should take action to implement those recommendations directed to Registered Training Organisations as outlined in the Battye Review. There does not appear to be any compelling reason to further postpone implementation of these recommendations, which were well considered. Aboriginal and Torres Strait Islander Health Workforce Training Package. Medium term – implementation should commence on a case-by-case basis as existing funding agreements expire.
Recommendation 5.8 The Commonwealth should consider options for the establishment of an Aboriginal and Torres Strait Islander Nursing and Midwifery Policy Adviser role within one of the nursing peak bodies. Aboriginal and Torres Strait Islander Health Workforce Training Package. Short term
Recommendation 5.9 The NT Medical Program’s Indigenous Transitions Pathway program should be further evaluated to assess its outcomes before considering future options for mentoring Aboriginal and Torres Strait Islander students. If the evaluation demonstrates positive outcomes in terms of increased students graduating and increased retention of these students in the surrounding communities, an increase in numbers and funding should be considered. Aboriginal and Torres Strait Islander Health Workforce Program, NT Medical Program Medium term
Recommendation 5.10 (shaded) The Commonwealth should further investigate activities related to the connectivity of the education and training sectors from school, through the vocational education and training (VET) sector and on to undergraduate studies, with multiple entry points supported for younger and mature students. This will encourage more Aboriginal and Torres Strait Islander students studying health professions (over 7000) in the VET sector to progress to tertiary-based study programs by building on their success in prior health education and training programs. Nil This is in part a DEEWR program responsibility. Short term – this policy work should commence following this Review.

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Managing the supply of health workers to meet community needs

International recruitment, support and regulation
Recommendation number Recommendation Affected programs Timeframe
Recommendation 6.1 (shaded) The Department should continue to work with medical professional groups, including the specialist colleges, to identify opportunities to improve professional support for overseas trained doctors (OTDs) in rural and remote areas. Support should be targeted to help doctors to meet the requirements for general and specialist medical registration, and provide ongoing peer mentoring particularly for OTDs in rural and remote areas. Nil Short term – ongoing.
Recommendation 6.2 Funding for Rural Workforce Agencies (RWAs) to deliver the International Recruitment Strategy (IRS) and recruitment and retention activity under Health Workforce Australia’s (HWA’s) International Health Professionals Program (IHPP) should be consolidated through one fund-holder. The most appropriate organisation to take on the fund-holder role should be negotiated with Rural Health Workforce Australia, HWA and the RWAs. If RWAs are to have a continuing role in this program, consideration should be given to enabling them to receive recruitment payments at the end of each funding period. IRS, HWA (IHPP) Medium term
Recommendation 6.3 The Commonwealth should explore opportunities to provide additional information about Medicare provider number restrictions to ensure OTDs have full and accurate information before accepting job placements. Nil Short term
Recommendation 6.4 The Commonwealth should give detailed consideration to the legislative changes and practical implementation requirements that would be needed to enable OTDs and their families to access Medicare rebates for health services received as patients. If access to Medicare cannot feasibly be delivered other support mechanisms should be considered to ensure reasonable access to health care for providers supporting the community. Consideration of this issue may also need to be extended to other overseas trained health professionals. MBS Medium term – subject to costing analysis, consideration of implications for Medicare and other policy areas (e.g. Immigration) and available funding.
Recommendation 6.5 The Commonwealth should consider amending s. 19AB of the Health Insurance Act 1973 to allow for the backdating of s. 19AB(3) exemptions, under limited circumstances. MBS Longer term
Recommendation 6.6 (shaded) The Commonwealth, through its role on the Standing Council on Health, should continue to encourage efforts to deliver a shared electronic repository for documents relating to the registration and employment of new OTDs, noting HWA’s current work with the Australian Health Practitioners Regulation Agency and the medical profession on this issue. The current requirements for multiple lodgement, inconsistent lodgement dates and formats are significant obstacles to effective workforce administration. HWA Longer term
District of Workforce Shortage classification system
Recommendation number Recommendation Affected programs Timeframe
Recommendation 6.7 (shaded) The Commonwealth should introduce a revised system to replace the current districts of workforce shortage (DWS) classification system. It should be introduced in 2 stages. Under the first stage, the geographic classification requirements of the revised system should be based on the Australian Statistical Geography Standard (ASGS), these requirements being: Remoteness area classifications as provided under the ASGS; and SA2/SA3 boundaries to be used as ‘area’ boundaries for workforce shortage classifications. 2011 census data (i.e. the most up to date data) should be used as the population measure for the revised system. The revised system should abandon the use of the additional overlay of the “metropolitan areas classification system” for general practice. The revised system should use a modified general practice workforce measure within major cities (RA1) and inner regional areas (RA2) comprised of: a comparison of the population-to-full-time equivalent (FTE) ratio of each area against the national average; the application of a 10% buffer to the raw population-to-FTE ratios; and a full-time workload equivalent (FWE)-to-GP ratio to areas that have better than the national average but fall within the 10% buffer zone. The second stage should consider the introduction of the use of the ‘modified Monash model’ proposed in chapter 4 to determine automatic DWS status for certain remoteness categories. If the ‘modified Monash model’ of geographical classification is implemented and its methodology can be applied to DWS in an administratively efficient manner, the following areas should be granted automatic DWS status for both general practice and other specialties: RA2 and RA3 areas with populations less than 15,000; RA4; and RA5. Additional discussions with stakeholders should be undertaken to assist in the implementation of the new system, including transition arrangements. This should include discussions with jurisdictions around how this new DWS system will overlap with their current Area of Need determinations. An implementation working group should be established. DWS, allocation of MBS provider numbers, BMP Short term – transitional arrangements, further discussions with stakeholders and the development of communication and data system should commence immediately post-Review. Medium term – it is likely that the work outlined above will necessitate medium term implementation of the full DWS changes.

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Achieving workforce distribution aims through return of service obligations
Recommendation number Recommendation Affected programs Timeframe
Recommendation 6.8 (shaded) Major reform to the operation of the Bonded Medical Places (BMP) scheme should be considered to address stakeholder concerns and escalating administrative challenges. The return of service obligation (RSO) required of medical students should be substantially altered to help make the scheme fairer and more certain for students as well as more efficient to administer. This should involve: Making designated rural areas permanently eligible for completion of the RSO period, removing the use of the districts of workforce shortage (DWS) system in these areas; Aligning eligible metropolitan areas for RSO with the reforms to the DWS system outlined elsewhere in this review, as well as allowing flexibility for graduates to work in high need metropolitan areas, such as community health settings like Aboriginal Medical Services; and Changing the RSO period to commence from attainment of fellowship to make the scheme administratively sustainable through basing it around access to Medicare provider numbers. To offset this change the Commonwealth should halve the maximum RSO period and retain the use of ‘scaling’ to encourage graduates to work in more remote areas. BMP Medium term – changes to the operation of the program could commence for new entrants from 2014, subject to consultation with universities and other stakeholders.
Workforce distribution programs targeted at non-vocationally recognised medical practitioners
Recommendation number Recommendation Affected programs Timeframe
Recommendation 6.9: (shaded) The Commonwealth should consolidate the existing Section 3GA workforce programs. All 3GA programs Medium term
Recommendation 6.10 (shaded) The Commonwealth should combine the After Hours Other Medical Practitioners program, the Medicare Plus Other Medical Practitioners program, the Rural Other Medical Practitioners program and the Outer-metropolitan Other Medical Practitioners program into a single program. In developing the program, issues to consider include: use of the revised geographical classification system proposed elsewhere in this report; grandfathering arrangements for pre-1996 medical practitioners; standardised specialist college training and continuing professional development requirements; expansion to include Aboriginal and Torres Strait Islander health services; interaction with s. 3GA workforce programs, specifically the Approved Medical Deputising Service program and Rural Locum Relief Program; and the potential for unintended negative outcomes for medical service provision in rural areas. All other medical practitioners programs Medium term
Recommendation 6.11 The Department should undertake a process with individual participants on the Temporary Resident Other Medical Practitioners (TROMPs) program so that a timeline can be set for all participants to indicate a clear intention about engaging with the relevant college on a process to proceed to fellowship. TROMPS Short term – small number of program participants.

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Nursing workforce – education, retention and sustainability

Nursing workforce – education, retention and sustainability
Recommendation number Recommendation Affected programs Timeframe
Recommendation 7.1 (shaded) The Commonwealth should work with the profession and across jurisdictions to establish a National Nursing and Midwifery Education Advisory Network (NNMEAN) that would develop five year rolling nursing education plans across the whole training pipeline from enrolled and undergraduate nurse training to advanced scopes of practice and nurse practitioner candidates. These plans will be based on the best possible nursing workforce data and take into account health service delivery requirements (both in the public and private sectors) and consider both the supply and demand issues. HWA, support through the Health Workforce Fund Medium term – formation of the network and the development of consensus on its role would take some time.
Recommendation 7.2 As part of the wider NNMEAN work, an appropriate organisation should be tasked with identifying and analysing the issues related to a perceived reluctance by employers to employ newly graduated nurses. Further, they should identify actions that could be taken in the undergraduate program to allay these issues and provide advice and options on how professional groups and employers could best support nurses to ensure they are retained within the profession upon graduation. HWA, support through the Health Workforce Fund Medium term – linked to the establishment of NNMEAN.
Recommendation 7.3 (shaded) The Commonwealth should consider providing seed funding for a feasibility study of a national rollout of leadership courses to mid-level nurse and midwife managers, based on the New South Wales Government sponsored Essentials of Care program. This would build on work that Health Workforce Australia (HWA) is doing in its Health LEADS Australia, health leadership framework. The Australian College of Nursing should lead this work and the resulting education activities should be considered eligible for support under various scholarship schemes until these courses are well established and sustainable under a user pays system. New funding – Health Workforce Fund Short term – work on this project could commence immediately post-Review, subject to available funding.
Recommendation 7.4 (shaded) The Commonwealth should consider providing flexible financial support under the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) of up to $10,000 (per recipient) for supervised re-entry courses for those registered nurses in regional, rural and remote locations, seeking to return to the workforce after extended periods away, until satisfactory flexible delivery or e-learning options are available in all states and territories. The University Departments of Rural Health (UDRH) program could potentially provide a platform for delivering this education in some rural and remote areas. NAHSSS Short term – redirection of NAHSSS priorities, existing funding.
Recommendation 7.5 (shaded) The Commonwealth should continue its investment in the Practice Nurse Incentive Program (PNIP) but the Nursing in General Practice Program (NiGP) should be integrated with the activities of Medicare Locals. PNIP, NiGP Short term – NiGP activities to be integrated with Medicare Locals from 2013-14.
Recommendation 7.6 The Commonwealth should develop a model based on the Remote Vocational Training Scheme (RVTS) model to allow distance education and supervision. This will allow highly qualified nurses working in rural and remote areas to access clinical experience and supervision while still delivering services in those areas. Additionally, the scheme could be modified to include education and supervision requirements associated with nurses undertaking extended scope of practice, such as advanced practice nurses or nurse endoscopists. These activities could support increased access to services for rural and remote communities. RVTS Medium term – subject to available funding and engagement with the profession.
Recommendation 7.7 The Commonwealth agencies involved in nursing education need to investigate the availability and cost of VET sector training as it relates to enrolled nurses. There are a declining number of enrolled nurse places/courses being offered and a reason raised within consultations was cost (approximately $16,000 for an enrolled nursing course). Enrolled nursing students/courses should be eligible for scholarship support. Research and policy development across DoHA, DEEWR and DIICCSRTE, scholarships. Longer term
Recommendation 7.8 The Commonwealth should undertake an analysis of activity in other similar countries, such as the United Kingdom, New Zealand and Canada where enrolled nurse positions (and therefore training) have been reduced or removed entirely. This work would inform policy development in this area. Recently these countries have revised the enrolled nurse role in response to community needs and workforce pressures. Nil – research and policy development Longer term

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Dental and allied health workforce development

Dental and oral health workforce
Recommendation number Recommendation Affected programs Timeframe
Recommendation 8.1 The Commonwealth should closely monitor the current work being undertaken by Health Workforce Australia (HWA) and the Dental Board of Australia (DBA) in relation to the scope of practice for oral health therapists, dental therapists and dental hygienists to inform the design of future health workforce programs. Nil Medium term
Recommendation 8.2 The Commonwealth should continue with the implementation of the Oral Health Therapists Graduate Year Program (OHTGYP), the Voluntary Dental Graduate Year Program (VDGYP) and the Dental Relocation and Infrastructure Support Scheme (DRISS). While implementation for these relatively new programs appears to be on track, it will be important to monitor outcomes. OHTGYP, VDGYP, DRISS Ongoing
Recommendation 8.3 (shaded) The Dental Training Expanding Rural Placements (DTERP) program has potential to provide increased numbers of student placements for a modest additional investment. Funding could be identified from within the existing Rural Health Multidisciplinary Training (RHMT) program, or through HWA. This program is strongly supported by the dental schools and appears to be delivering useful outcomes for the distribution of the dental workforce and to expand the service learning model. DTERP, RHMT Short term – dental schools have advised that this program is ready to be expanded almost immediately, subject to receiving extra funding.
Recommendation 8.4 (shaded) The Australian Rural Health Education Network (ARHEN) proposal for a rural oral health academic program has merit and should be explored further in close consultation with dental schools, as a way of supporting the dental workforce in rural locations. The alignment of this potential new investment with the existing DTERP program needs to be carefully considered to avoid potential overlap, noting that some University Departments of Rural Health (UDRH) have the potential to act as new training sites for dental and oral health students. UDRH program Medium term – subject to available funding.
Recommendation 8.5 The Commonwealth should encourage key agencies (e.g. HWA and the Australian Institute of Health and Welfare) to improve data collection to inform policy development of the dental and oral health workforce. This should include better data on workforce distribution and the academic dental workforce. Nil Longer term
Allied health workforce
Recommendation number Recommendation Affected programs Timeframe
Recommendation 8.6 (shaded) The Government’s recent announcement of the establishment of a Commonwealth Chief Allied Health Officer is supported. This new position should play an important role in providing advice on policy and allied health workforce reform. Nil Short term – this appointment is likely to commence in 2013.
Recommendation 8.7 The Commonwealth should consider options aimed at enhancing its ability to liaise and consult with the allied health disciplines. This could be pursued through supporting the development of a Coalition of National Nursing Organisations type-model, where allied health stakeholder representatives would meet regularly with senior representatives of the Department, including the Chief Allied Health Officer. Nil – new secretariat funding, potentially through the Health Workforce Fund. Short term – linked to the appointment of the Chief Allied Health Officer.
Recommendation 8.8 (shaded) The Commonwealth should consider providing seed funding to establish allied health networks and professional hubs in rural areas. This would assist in peer support, ensuring adequate supervision of students and new practitioners, and access to continuing professional development. This is essential to ensure service delivery is based on contemporary practice and is more sustainable (particularly in the private sector). Innovative methods of communication and activities such as telehealth, online training and assistance to develop new professional support networks could be funded through this approach. Nil – new funding required. Medium term- Subject to available funding.
Recommendation 8.9 The Commonwealth should explore the possibility of expanding the list of eligible Telehealth specialist support items to include specific allied health services, including optometry. Close consultation with the Medicare Benefits Division in regard to the feasibility of the recommendation is essential. MBS Medium term – subject to discussions with MBD and available funding.
Recommendation 8.10 The Commonwealth, in conjunction with HWA, should continue to research and pilot projects to test and implement new roles and responsibilities for allied health assistants, initially in rural areas. Ongoing research into the clinical effectiveness and safety of allied health assistants needs to be undertaken examining the productivity gains and benefits to community services of developing this workforce. HWA, with potential future support through the Health Workforce Fund, if required. Longer term
Recommendation 8.11 Regionally based agencies such as Medicare Locals and local health networks (LHN) could play an important role in the development of an integrated approach to the employment of allied health professionals. Options for the Medicare Locals and LHN networks to address the lack of allied health private practitioner services in rural areas (with the resultant current limited ability to access private health and Commonwealth MBS items) should be explored further. Although comprehensive HWA data is not yet available, it seems clear that rural communities have significantly less access to private allied health services when compared to metropolitan areas. The Commonwealth may need to address market failure through exploring models of collaboration between health services (health and disability sectors) as well as private/public partnerships in smaller communities. Medicare Locals, MBS. Longer term
Recommendation 8.12 The concerns and representations of allied health workforce stakeholders raised in the course of this review should be forwarded to Health Workforce Australia (where relevant) for its information and appropriate action. This may improve engagement with the professions and individual practitioners, particularly those employed outside of hospitals. HWA Short term

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Opportunities for reform in program delivery and policy development

Grants management reform
Recommendation number Recommendation Affected programs Timeframe
Recommendation 9.1 (shaded) The Health Workforce Division (HWD) should continue to implement the whole-of-department reforms to grants management, with a view to improving consistency of funding arrangements and achieving measurable reductions in compliance-based reporting and unnecessary focus on process rather than results. Regular feedback should be sought from peak groups as to whether the reform process is in fact achieving a reduction in red tape and administrative cost for funded agencies. As part of this process, it will be important to: Establish a consistent approach to developing funding agreements, particularly in terms of detailing the key activities for each project/program. This process needs to focus on clearly defining activities while reducing the reporting burden for stakeholders. Ensure outcomes measures and reporting requirements are based on a set of easily identifiable and measureable key performance indicators. Wherever possible, align funding agreement periods within the Health Workforce Fund (HWF) to reduce the need for organisations to continually engage in multiple funding processes with different program areas; Attempt to integrate the current multiple funding streams across HWD and other Divisions. This may need to involve further consolidation of funding appropriations within the most appropriate flexible fund. All Health Workforce Fund Programs Short term – ongoing grants management reform.
Recommendation 9.2 Divisions within the Department should closely examine linkages in their health workforce programs and implement measures to reduce or remove duplication or overlap within their current programs. To help ensure this occurs effectively, consideration should be given to establishing a formal and regular communication system between key divisions involved in health workforce programs. All Short term and ongoing
Recommendation 9.3 (shaded) In the development of new policy proposals, the department should give specific consideration to health workforce impacts, potentially through the preparation of new internal health workforce impact statements. Policy development Medium term – ideally to commence for the 2014 Budget process and beyond.
Recommendation 9.4 (shaded) A comprehensive evaluation strategy should be developed for the various health workforce programs and activity areas. This should be designed to ensure consistency with the broader evaluation framework of the HWF and be applied consistently across all funding activities. In particular, new programs should not be rolled out without an outcome-based evaluation framework. HWF and health workforce programs outside the fund Short/medium term – post-review work to commence in 2013-14.
Recommendation 9.5 A comprehensive assessment of internal DoHA risk management compliance across all health workforce program activity areas should be undertaken following this review. In addition to the broader risk management plan for the HWF, component initiatives should have risk management plans in place and update them consistently. Any such review needs to be undertaken within the context of the broader reforms to contracting practices within the department. HWF Short/medium term – post-review work to commence in 2013-14.
Health Workforce Australia and Health Workforce Division: roles, responsibilities and options for reform
Recommendation number Recommendation Affected programs Timeframe
Recommendation 9.6 (shaded) This review has identified legitimate stakeholder concerns about the lack of clarity defining the respective roles of Health Workforce Australia and DoHA, as well as inconsistencies in the delivery of Commonwealth funding between the two agencies. It is likely that current arrangements are less than optimal. This issue needs to be addressed to ensure the Commonwealth gains the best value from its investment in HWA and departmental programs. Issues raised in in the course of this review may inform the forthcoming overarching review of the National Partnership Agreement on Hospital and Health Workforce Reform (NPA), which will include consideration of Schedule B of the NPA and those items relating to HWA functions. There are three broad changes that should be considered by the Commonwealth in this area: Option 1 – HWA becomes a specialist data and policy agency ‘think tank’ and does not manage mature programs HWA’s programs could be managed by the Department which would enable HWA to focus on its data analysis and policy development work. HWA would retain a budget for innovation and reform; to support ‘pilot approaches’ which may be, if successful, applied more broadly through DoHA program funding. Option 2 – HWA takes over the management of selected DoHA programs HWA could take over responsibility for the management of a number of DoHA programs to ensure synergies in program management and policy. Examples include the consolidation of HWA Clinical Training Program and HWD’s Rural Clinical Training and Support program; and the transfer of the Specialist Training Program. In the event that the overarching NPA review does not provide sufficient analysis to inform these options, it may be necessary to undertake a specific independent analysis of HWA’s activities and governance arrangements, building on information gathered in the course of this review and in the NPA process to inform future directions for the national health workforce agency. Option 3 – HWA operations remain the same HWA’s current arrangements continue with HWA having responsibility for both program and policy development. However, if this ‘status quo’ option is pursued, at a minimum, the roles and responsibilities of both agencies will need to be clarified for the benefit of stakeholders and more effective communication channels need to be established at the program management level to enhance collaboration. Health workforce training programs and HWA funding programs. Longer term – reform would need to be pursued on the expiry of current long-term funding agreements and be linked to the completion of structural reviews of both HWA and the larger health workforce environment.

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Stakeholder support
Recommendation number Recommendation Affected programs Timeframe
Recommendation 9.7 (shaded) To standardise funding arrangements for stakeholder support, the Department should consider future competitive targeted funding rounds. Stakeholder support should focus on the identified priorities for the HWF and be based on current and emerging health workforce issues. Organisations including (but not limited to) CoNNo, CPMC, MDANZ , AMC, SARRAH, NRHSN and CRANAplus. Medium term – aligned with the expiry dates of current funding agreements.
Recommendation 9.8 To reduce the burden of multiple application processes and reduce payment timing difficulties and reporting requirements, the Commonwealth should consider co-locating all funding for a similar purpose within one flexible fund – either the HWF or the Health System Capacity Development Fund. As above Medium term – aligned with flexible fund management and the timing of scheduled application processes.

208 Major recommendations are shaded.