In response, in part, to growing specialisation within professions, a number of more generalist roles and professions are developing which are particularly applicable for providing primary health care services to smaller communities. In the United States of America, United Kingdom and New Zealand, the nurse practitioner role has been developed for some time. This has also been trialled in Australia to a limited extent. There are currently around 220 nurse practitioners in Australia, who generally work in state and territory health services. As yet, very few are working in rural areas.
The role of physician assistants has been long established in the United States of America and is increasingly providing services there to smaller communities, usually rural and remote, under the overall guidance of a medical practitioner. These are currently being trialled in Queensland, South Australia and Western Australia.
Despite the continuing trend to subspecialisation within the medical specialties, including in general practice, there is an appreciation by most Australian medical colleges that generalist practice within specialties has an important role to play in patient care and should be encouraged. Such generalists are likely to play a greater role in outer metropolitan and rural areas, and those colleges that support rural training frequently link this to general training. This has significant implications, however, in that generalist training necessitates learning about and maintaining knowledge and skills across a range of areas (as opposed to knowing much about a more discrete area of practice) and this can raise issues, such as regards a practitioner's ongoing training load and medical indemnity.
There are several initiatives across Australia that focus on generalist practice, for instance the following:
- In Queensland a specific rural generalist pathway has been developed by Queensland Health in association with the Australian College of Rural and Remote Medicine (ACRRM). A similar pathway is currently under development in Western Australia.
- A number of Australian Government programs are available to support GPs maintain or develop procedural skills relevant to practising in rural and remote Australia.
- New South Wales Health has developed a hospitalist model, which aims to produce hospital-based doctors who can assist with the management of the patient journey in major metropolitan hospitals, to ensure patients have continuity of care when multiple specialists are involved in their treatment.