Primary Health Care Sector

Industry Skills and Workforce Development Report: June 2012

The Workforce Council acknowledges Aboriginal and Torres Strait Islander people as the original inhabitants of Australia and recognises these unique cultures as part of the cultural heritage of all Australians. We respectfully acknowledge the traditional custodians of the land on which we do our work across Queensland. For more information on our commitment to Reconciliation visit www.workforce.org.au/about/reconciliation All portraits are a part of the Workforce Councils Photo Exhibition http://www.workforce.org.au/gallery/our-people.aspx

Contents
4 5 8 10 13 15 18 20 21 21 22 Industry Sector Profile Training Profile Economic, social demographic, environmental and technological factors Government Policies impacting on the industrys workforce Identification and Prioritisation of gaps between the existing workforce and future workforce needs Demand and supply disparities Advice concerning training product, pathways, training quality and delivery methods Key Achievements Ten Year Skilling and Workforce Development Outlook Five Year Skilling and Workforce Development Priorities Priorities for action over the next year

Primary Health Care Sector Industry Skills and Workforce Development Report: June 2012

This report summarises information related to the Queensland Primary Health Care Sector to date. It forms part of the Industry Skills and Workforce Development Report for the Community Services and Health Industries, June 2012. Information in this report has been validated through consultation with industry stakeholders.

PROFILES
Primary health care is commonly viewed as the first level of care or as the entry point to the health care system for consumers.1 In addition, primary health care is increasingly being seen as all health care services provided outside the hospital.2 In the Australian context, a commonly used definition of primary health care developed by the Australian Primary Health Care Research Institute is: socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems with a suitably trained workforce comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives priority to those most in need and addresses health inequalities; maximises community and individual self-reliance, participation and control; and involves collaboration and partnership with other sectors to promote public health.3 The most recognisable services in the primary care sector are general medical practices, the new Medicare Locals (replacing previous Divisions of General Practice), community health services, private clinics and Aboriginal medical services. In addition to providing direct medical care, these services also commonly provide allied health services such as physiotherapy, speech pathology, counselling and psychology services, acupuncture, etc. Many primary health services also provide preventive health, health promotion, education and care coordination services to the community. Currently, the Australian primary health care system is facing workforce shortages.4 Though precise quantification is difficult, there are evident shortages in general practice, various medical specialty areas, dentistry, nursing and some key allied health areas.5 Creating a strong, flexible and responsive primary health care sector and workforce is critical given the complex, fragmented and often uncoordinated delivery systems that operate across primary health care that have implications for the services individuals receive, how they pay for them, and how care providers interact and provide care.6 The primary health care sector plays an important role in the health care system with four out of five Australians attending a General Practitioner or other primary care professional at least once a year.7 However, Australias primary health care sector operates as a disparate set of services, so instead of a system it is often described in terms of occupations that work within it such as general practitioners,

Industry sector profile

1 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to Support Australias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphcdraftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012) 2 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to Support Australias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphcdraftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012) 3 Department of Health and Ageing, Commonwealth of Australia, Primary Health Care Reform in Australia: Report to Support Australias First National Primary Health Care Strategy. (Canberra, 2009), 24. 4 Australian Institute of Health and Welfare. 2009. Health and community services labour force 2006.National health labour force series no. 42. Cat no. HWL 43. Canberra: AIHW 5 Productivity Commission, Australian Government. 2005. Australias Health Workforce, Productivity Commission report on Australias health workforce. http://www.pc.gov.au/__data/assets/pdf_file/0003/9480/healthworkforce.pdf (accessed April 4th 2012) 6 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to Support Australias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphcdraftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012) 7 Commonwealth of Australia. 2011. National Health Reform - Improving Primary Healthcare for all Australians. http://www.healthissuescentre.org.au/documents/items/2011/02/363952-upload-00001.pdf (accessed March 3rd 2012)

Health and Community Services Workforce Council

practice nurses, psychologists, physiotherapists, community health workers, and pharmacists.8

Training Profile

Qualifications in Aboriginal and/or Torres Strait Islander Primary Health Care represent the most significant area of delivery for the primary health care sector. These qualifications are directly related to Indigenous Health Worker roles within Queensland Health as well as Health Workers employed in Aboriginal Medical Services. Delivery of the Certificate III peaked in 2008/09 following the introduction of this qualification in the 2007 Health Training Package. Numbers in this qualification have dropped in the following two years and on the basis of data for the period 1 July 2011 to 31 March 2012, enrolments this financial year will be similar to 2010/11. Enrolments in the Certificate IV are gradually increasing thanks to targeted strategies in both Queensland Health and the Aboriginal Medical Services.

The General Practice sector in Queensland has begun utilising national training package qualifications, and some of the Medicare Locals and the state body are delivering training in partnership with registered training organisations. As a result, delivery of Practice Management and Population health qualifications is emerging. The Certificate IV in Medical Practice Assisting is designed to support an emerging role for administration staff in general practice to support patient care.

8 Department of Health and Ageing, Commonwealth of Australia. 2010. Building a 21st Century Primary Health Care System Australias First National Primary Health Care Strategy. http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/3EDF5889BEC00D98C A2579540005F0A4/$File/6552%20NPHC%201205.pdf (accessed March 4th, 2012)

Primary Health Care Sector Industry Skills and Workforce Development Report: June 2012

Current industry and workforce reforms are being driven through national and state government policies and mandates which are vital in altering the structural design of the system
6

Indigenous Environmental Health qualifications are used by Queensland Health to support a relatively small workforce in Indigenous communities in the Cape and Gulf regions.

Primary Health Care Sector Industry Skills and Workforce Development Report: June 2012

CHALLENGES IMPACTING ON THE INDUSTRYS WORKFORCE Economic, social demographic, environmental and technological factors

The demand for primary health care services is expected to increase due to such factors as the rise in chronic and complex disease, an ageing population with multiple co morbidities, workforce shortages in other parts of the health system, geographical dispersion, increasing health care costs, advances in technology and changes in inter-professional service delivery models of care.91011 A health system approach advocated by government reports has implications for workforce development. These approaches include utilising the social determinants of health promoted by the World Health Organisation as a tool for locating specific pre-dispositions to disease across Queensland to inform deployment of health care workforce. Current industry and workforce reforms are being driven through national and state government policies and mandates which are vital in altering the structural design of the system. However, the implementation of workforce changes ultimately occurs at the local level by practitioners and organisations themselves across private, public and non-government environments. Queensland varies from other states in many areas including population, distribution of population and workforce, impact of resources boom and the political environment which all shape the local, regional and state landscape. This creates an imperative to understand the Queensland environment to inform an appropriate and effective approach to the implementation of workforce strategies. Demographics The primary health care workforce, based on people employed in general practice medical services and community-based dental, allied health and pharmacy services, including nurses, is around 137,600 equating to approximately 25% of the health workforce (Department of Health and Ageing 2009, Australian Institute of Health and Welfare 2006). This includes 20% of the 17,700 medical specialists in Australia who work in primary care settings (Australian Institute of Health and Welfare 2006). From an international perspective, Australia is not considered to have a critical shortage of health workers, the number of people working in health occupations increased by 11.4% compared with an 8.7% increase in the total civilian workforce.12 In 2002 Queensland had the lowest number of registered medical practitioners per head of population in Australia, decreasing from 236 per 100,000 in 1997, to 220 in 2002. This is particularly concerning when Queensland has experienced unprecedented levels of population growth. Outside capital cities, the fastest growth in 2008-09 occurred along the Australian coast especially in the regional areas of the Gold Coast, Sunshine Coast, Townsville and Cairns in Queensland.13
9 National Health and Hospitals Reform Commission, A Healthier Future For All Australians Final Report of the National Health and Hospitals Reform Commission. (Canberra, 2009);, http://www.biomedcentral.com/1472-6963/8/249 10 Tran, D. et al, Identification of recruitment and retention strategies for rehabilitation professionals in Ontario, Canada: results from expert panels, BMC Health Services Research 8 (2008) 11 Humphreys and Wakerman. Primary health care in rural and remote Australia: achieving equity of access and outcomes through national reform, (2008). 12 World Health Organisation. 2008. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf (accessed February 26th 2012) 13 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov. au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March 25th 2012)

Health and Community Services Workforce Council

There is however, significant disparity in the number of health care professionals between metropolitan and the most remote parts of Australia.14 In 2006 the most remote areas had significantly fewer general medical practitioners, registered nurses and allied health workers per 100 000 population compared to major cities - 64 allied health workers per 100 000 population compared to 354 per 100 000 in major cities.15 This pattern of health worker disparity in rural and remote areas is exacerbated within the primary health care workforce. Components of that growth are important for establishing health care where the service is needed. In 2006, Queensland had the second largest number of Aboriginal and Torres Strait Islander people (144,900) after NSW (152,700), however, the Indigenous population of Queensland is projected to be the fastest growing of the states and territories which will grow by 34.9% by 2021.16 There are significant gaps in Indigenous participation in the health workforce. There is a relatively small number of Indigenous people in the health workforce and a shortage of workers, particularly health professionals, in indigenous health. In 2006, while Aboriginal and Torres Strait Islander people made up 3.5% of the population of Queensland, only 1.4% of the health workforce was indigenous (Australian Institute of Health and Welfare 2008). These workers are unevenly distributed across the state in ways that impact on Aboriginal and Torres Strait Islander health services. Ageing Workforce Generational changes mean that many providers are not working the same long hours or practising in the same way as their predecessors17 The informal carer workforce currently providing much of the services to the aged18 is likely to diminish as people stay longer in the workforce and are less available to assist the aged and chronically ill to stay at home. The warning is that number alone will not address the ageing workforce challenges. Regard for the types of needs of the community and matching the skills to those needs is essential with an overarching focus on well-ness to prevent disease. Workforce planning is considered a major problem in the primary health care sector for Aboriginal and Torres Strait Islander services. The Queensland Aboriginal and Torres Strait islander Health Council (QAIHC) advocates under the reform of Medicare Locals a new model of the QAIHC Comprehensive Primary Care Model in response to the workforce impacts on service provision for the Indigenous part of the sector. This model relies on a Community Health Plan and a Health Services Plan. Thorough though this model is, it relies on exponential growth in
14 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov. au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March 25th 2012) 15 Australian Institute of Health and Welfare. 2009. Health and community services labour force 2006.National health labour force series no. 42. Cat no. HWL 43. Canberra: AIHW 16 Australian Bureau of Statistics. 2009. Experimental Estimates and Projections, Aboriginal and Torres Strait Islander Australians, 1991 to 2021. Cat. No 3238.0, 2009, Australian Bureau of Statistics. http://www.abs.gov.au/ausstats/abs@.nsf/mediareleasesbytitle/5D8264F4B08 3F282CA25762A002726E3? (accessed 24/04/12) 17 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Action 20112015. https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April 20th 2012) page 3 18 Productivity Commission, Australian Government. 2005. Australias Health Workforce, Productivity Commission report on Australias health workforce. http://www.pc.gov.au/__data/assets/pdf_file/0003/9480/healthworkforce.pdf (accessed April 4th 2012)

Primary Health Care Sector Industry Skills and Workforce Development Report: June 2012

the workforce and the expansion of current knowledge and skills to move to a community approach to the social and environmental determinants of growth. Workforce disadvantage in the Indigenous sector of primary health care has two aspects. The first is the relatively small number of Indigenous people in the health workforce and the second is the shortages of workers, particularly health professionals, in Indigenous health. In 2006, while Aboriginal and Torres Strait Islander people made up 3.5% of the population of Queensland, only 1.4% of the health workforce was Indigenous.19 Nationally, only 0.2% of GPs, 0.2% of specialists, 0.4% of midwives, 1.0% of nurses in community health and 0.6% of nurses working in mental health were Indigenous. These figures demonstrate significant gaps in Indigenous participation in the health workforce which is a major problem given national and international recognition of the importance of engagement of communities in their own primary health care if appropriate outcomes are to be achieved. Shortages of workers in Indigenous health are widely acknowledged. Queensland is the countrys most decentralised state and in 2002 it had the lowest number of registered medical practitioners per head of population in Australia, decreasing from 236 per 100,000 in 1997, to 220 in 2002. These will be unevenly distributed across the state in ways that impact on Aboriginal and Torres Strait Islander health services. National data show that the Full Time Employment (FTE) rate of employed primary care practitioners was highest in areas where less than 1% of the population was Indigenous (108 per 100,000 population) and lowest in areas where more 10% of the population was Indigenous (87 per 100,000 population).20 Other professions are also in short supply in Queensland including experienced nurses and allied professionals, especially in rural and remote areas where many Aboriginal and Torres Strait Islander people live.21

Government policies impacting on the industrys workforce

National Health and Hospitals Reform One of the key initiatives of the National Health and Hospitals Reform is the establishment of Medicare Locals from the previous Divisions of General Practice. Medicare Locals have been created as independent legal entities (not government bodies) and act as regional primary health care organisations. Medicare Locals have entirely new governance arrangements for the provision of primary health care than previously was the case under Divisions. These primary health care organisations are charged with responding to the health needs of their communities. The introduction of primary health care organisations in Australia follows the international trend with the establishment of Primary Care Trusts in the United Kingdom and Primary Health Organisations
19 Australian Institute of Health and Welfare. 2008. Aboriginal and Torres Strait Islander Health Performance Framework, 2008 report: Detailed analyses. Cat. no. IHW 22 20 Australian Institute of Health and Welfare. 2008. Aboriginal and Torres Strait Islander Health Performance Framework, 2008 report: Detailed analyses. Cat. no. IHW 22 21 Queensland Government. 2005. Queensland Strategy for Chronic Disease 2005-2015, promoting a healthier Queensland. http:// www.health.qld.gov.au/chronicdisease/documents/strat2005to15_full.pdf (accessed February 13th 2012)

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in New Zealand22 (Department of Health and Ageing 2009). Both the New Zealand and United Kingdom primary health care arrangements have been established for close to ten years. Learning from these experiences particularly in terms of the potential funds management role and the impact of this would prove useful in shaping Australian policy. Through the National Health and Hospital Reform Queensland has a total of 11 Medicare Locals. The 11 Medicare locals were introduced through a staged National process between 1 July 2011 and 1 July 2012.23 Adding to this environment of change is a range of state based policy initiatives which directly impact on the primary health care sector. These include: the Queensland Chronic Disease Strategy 2006-201524 The Health Consumer Queensland Consumer Engagement Framework25 (Health Consumer Queensland), Securing a Skilled Future Skills and Workforce Development Investment Plan, 2012-2013,26 and The Queensland Compact.27 In the midst of the roll out of national and state reforms and policy initiatives, 2012 saw a change in government in Queensland to the Liberal National Party. What focus the government will place on the on the primary health care sector and its policy position on the national reforms remains to be seen. None the less, the sectors ability to attract attention and investment levels required to successfully implement change framed through the national reforms must remain an area of priority for the primary health care sector. The currency and size of some reforms for example, the establishment of Medicare Locals, requires greater clarity as to their impact and role in workforce reforms and workforce issues. This includes key elements such as clarity about the governance arrangements of organisations involved in implementing primary health care workforce reforms.28 Consequences of other reforms such as the introduction of an entitlement model within the Vocational Education System are also yet to be clearly understood. The entitlement model will allow individuals to choose their course and their registered training organisation funding following them. This may result in significantly increased public investment in the training system and an altered relationship between student and training organisation.29 Industrial and Regulatory The reform around Medicare Locals with independence from uniform industrial relations is predicted to impact each Medicare Local as it undertakes workforce planning to meet the needs in each community. The new environment in primary health care will have implications for the
22 Department of Health and Ageing, Commonwealth of Australia. 2009. Primary Health Care Reform in Australia Report to Support Australias First National Primary Health Care Strategy. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphcdraftreportsupp-toc/$FILE/NPHC-supp.pdf (accessed March 15th 2012) 23 Department of Health and Ageing (n.d.) My Medicare Local. http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/medilocprofiles. (accessed February April 4th 2012) 24 Queensland Government. 2005. Queensland Strategy for Chronic Disease 2005-2015, promoting a healthier Queensland. http:// www.health.qld.gov.au/chronicdisease/documents/strat2005to15_full.pdf (accessed February 13th 2012) 25 Health Consumer Queensland, Queensland Government . 2012. Consumer and community engagement framework. http://www. health.qld.gov.au/hcq/publications/consumer-engagement.pdf (accessed April 24th 2012) 26 Skills Queensland. 2012. Skills and Workforce Development Investment Plan 2012-2013. People Potential Prosperity http://www. skills.qld.gov.au/Functions/Workforce-development/skills-and-workforce-development-investment-plan.aspx#Securingaskilledfuture (accessed May 3rd 2012) 27 Queensland Government. 2008. Queensland Compact. Towards a Fairer Queensland. http://www.communities.qld.gov.au/communityservices/about-us/corporate-plans/queensland-compact-towards-a-fairer-queensland (accessed February 12th 2012) 28 Naccarella.L., Buchan, J., and Newton. B., and Brooks, P . 2011. Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad Australian Health Review 35: 262266. www.publish.csiro.au/journals/ahr (accessed March 15th 2012) 29 Health and Community Services Workforce Council. 2012. Queensland State Election, Policy Analysis. Unpublished document - Prepared for Queensland Industries Reference Group Meeting 29 March 2012

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identity of the primary health care sector. For example, Medicare Locals are charged with stronger engagement with the aged and community care sector, a sector which has recently amalgamated a number of organisations to produce a single national voice. Workforce reforms underway focus on increasing workforce supply through education/training initiatives, changing the skill mix and extending the roles of health workers to improve resource utilisation and better meet patient needs.30 Some examples of system wide workforce initiatives include substantially increasing the number of clinical training places; establishing lead agencies and entities including, Regional Clinical Training Networks, Health Workforce Australia, a single National Registration and Accreditation Scheme, and the progression of the national e-health strategy. There are current regulatory barriers to ongoing reform of the health workforce with professional accreditation bodies policy and practices being both enablers and barriers to workforce reform. Health related reform initiatives and strategies are being progressed to improve health services and increase the health workforce in rural and remote areas that ultimately can improve the health and welfare of Indigenous Australians. These include the Closing the Gap initiatives through the Council of Australian Governments,31 the development of a Rural and Remote Health Workforce Innovation and Reform Strategy by Health Workforce Australia32 and the production of a 20 point plan twenty steps to equal health by 2020 by the National Rural Health Alliance.33 Exacerbating and limiting workforce change are industrial and regulatory issues which need to be addressed to realise fundamental changes in job design, scope of practice, professional demarcation and the creation of new roles.34 Such examples include different industrial instruments across private, government and non-government funded services, rigid regulatory arrangements often influenced by professional groups and the inflexibility and inconsistency in regulatory and accreditation arrangements. These issues have a significant impact on the ability of the workforce to introduce changes such as creating new roles and or expanding the scope of others. This is of particular relevance for the primary health care sector where a key concept underpinning the approach within the sector is the role of the health professional as part of a health care team, which is vital in the management of chronic disease.35 The National Accreditation Scheme introduced in 2009 does attempt to address some of these issues through the introduction of national accreditation and registration arrangements for key professions. In particular Aboriginal Health Worker accreditation has produced problems which are outlined later in the report. Technology The National e-health strategy whilst not a specific workforce reform will have a substantial impact on how the workforce operates. Operating in a more electronic and technologically connected environment will require not only system and structure changes but a particular focus on enhancing the skills and capability of the workforce. The building of Australias E-Health skills capacity and
30 Brooks, P ., Ellis, N. 2007. Health workforce reforms, Workforce rising to the challenge. http://cpd.org.au/article/health-workforcereform-rising-to-the-challenge [Verified July 2008] (accessed 16th March 2012) 31 Queensland Aboriginal and Islander Health Council. 2011. A Blueprint for Aboriginal and Islander Health Reform in Queensland. Official Launch October 2011. http://www.qaihc.com.au/resources/publications/ (accessed March 15th 2012) 32 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov. au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March 25th 2012) 33 National Rural Health Alliance. 2012. Twenty Steps to Equal Health by 2020: The NRHAs 20-Point Plan for improving health services and health workforce in rural and remote areas. http://nrha.ruralhealth.org.au/cms/uploads/publications/twenty_steps_to_equal_health_for_ website_11may2012.pdf (accessed April 12th 2012) 34 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Action 20112015. https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April 20th 2012) 35 Brooks, P ., Ellis, N. 2007. Health workforce reforms, Workforce rising to the challenge. http://cpd.org.au/article/health-workforcereform-rising-to-the-challenge [Verified July 2008] (accessed 16th March 2012)

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capability will require the national coordination of changes to vocational and tertiary training programs.36

Major national health initiatives in recent years have emphasised the need for the health industry to refocus on wellness, prevention and primary health care if it is to be sustainable in the future. Such a change will require re-configuring not only the workforce but the education and training programs that prepare and support them.3738 Meeting the aims of primary health care is labour-intensive and calls on many professions. Australia is facing a primary health care workforce shortage exacerbated by increasing complexity and fragmentation in the health system.3940 The key challenges for Australias primary health care workforce are across the areas of supply, distribution, changing demands, and role delineation.41 Workforce planning in the health industry has traditionally been based around professions and occupations. A shift towards methods, including models of care approaches that facilitate the integration of new approaches to workforce design and workforce planning has been emphasized.42 Despite this over the last 10 years workforce planning has continued to be organized around professions, not targeted to primary health care specifically, and has been responsive primarily to funding streams.43 To achieve the shift from profession and discipline-based workforce development requires fundamental structural and cultural change.44 These mechanisms have driven a continued focus on Australian health and workforce reforms and have recognised the need to think differently and re-engineer our system and our workforce to focus more on the primary health care setting. Whilst
36 Australian Health Ministers Advisory Council. 2008. National e-health Strategy Summary, December 2008. http:// www.ahmac.gov.au/cms_documents/National%20E-Health%20Strategy.pdf (accessed 23rd May 2012). 37 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Action 20112015. https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April 20th 2012) 38 Commonwealth of Australia. 2008. A long-term national health strategy. Australia 2020 Summit Final Report. http://www.australia2020.gov.au/docs/final_report/2020_summit_report_5_health.pdf (accessed March 15th 2012) 39 Commonwealth of Australia. 2005. Australias Health Workforce. Research report. Canberra. http://www.pc.gov. au/__data/assets/pdf_file/0003/9480/healthworkforce.pdf [Verified September 2008] (accessed March 17th 2012) 40 Council of Australian Governments. 2006. COAG Response to the Productivity Commission Report on Australias Health Workforce. http://www.coag.gov.au/coag_meeting_outcomes/2006-07-14/docs/attachment_a_response_pc_health_ workforce.pdf [Verified October 2008 (accessed April 3rd 2012) 41 Douglas, K. A., Frith. K., Laurann, L. E., Wells, R. W., Glasgow, N. J., Humphreys, J. S.. 2009. Australias primary health care workforce research informing policy. Medical Journal of Australia Volume 191 Number 2 42 Australian Health Workforce Advisory Committee and Australian Medical Workforce Advisory Committee. 2005. A Models of Care Approach to Workforce Planning - Information Paper, Health Workforce Information Paper 1, Sydney. http:// www.ahwo.gov.au/documents/Publications/2005/A%20models%20of%20care%20approach%20to%20health%20workforce%20planning.pdf (accessed March 14th 2012) 43 Brooks, P ., Ellis, N. 2007. Health workforce reforms, Workforce rising to the challenge. http://cpd.org.au/article/ health-workforcereform-rising-to-the-challenge [Verified July 2008] (accessed 16th March 2012) 44 Francis, S., Carswell, P ., North, N., Gauld, R., Brooks, P ., Wakerman, J. 2010. Commentary - Challenging Workforce planning approaches Asia Pacific Journal of Health Management 2010; 5:2

Identification and prioritisation of gaps between the existing/ forecasted workforce and future workforce needs

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the importance of the primary health care sector is specifically acknowledged through Building Block 3: A Skilled Workforce within the National Primary Health Care Strategy45 there is a lack of targeted and tailored attention to lead an industry driven whole of primary health care sector workforce vision and related workforce strategies at national and state levels. Although there is recognition that alternate approaches to workforce planning are required, a lack of debate exists about primary health care workforce planning, despite the national emphasis on overall strengthening of the primary health care system.46 There continues to be insufficient investment in research and workforce development in primary health care in Australia.47 The primary health care system is complex and there is acknowledgment of the need to build the capacity of the sector to shift the paradigm of health care in Australia. Facilitating change in an environment characterised by extreme politicisation, power inequities created through strongly established occupational hierarchies, confusing and ineffective funding mechanisms and a lack of a whole-of-system approach to building capacity is a challenge for practitioners, managers and leaders. The lack of clarity and debate concerning the approach to the primary health care workforce hampers the ability to facilitate a whole-of-sector approach to planning.48 There continues to be inconsistent interpretations of the sector by experts within it concerning the scope of service and support within the sector; and an ongoing preference to describe the sector in terms of occupations.

PRIORITIES Increase capacity of the sector to carry out workforce planning based on agreed scope of the primary health care sector Explore new models which provide for discipline-based workforce development in addition to the more traditional professional based workforce development Increase the provision of training and development in workforce management of multi-disciplinary teams in integrated service models of care Increase leadership and change management training and professional development to ensure a capacity to prepare and manage a diverse and flexible workforce Training and development programs redesigned to enable new and changed roles and respond to the multiple reforms in the industry. Increase provision of training and skills in areas expected to increase in demand into the future including dementia care, counselling and community mental health.

45 Department of Health and Ageing, Commonwealth of Australia. 2010. Building a 21st Century Primary Health Care System Australias First National Primary Health Care Strategy. http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/3EDF5889BEC00D98C A2579540005F0A4/$File/6552%20NPHC%201205.pdf (accessed March 4th, 2012) 46 Naccarella.L., Buchan, J., and Newton. B., and Brooks, P . 2011. Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad Australian Health Review 35: 262266. www.publish.csiro.au/journals/ahr (accessed March 15th 2012) 47 Public Health Association of Australia. 2011. Policy at a glance, primary health care policy. http://www.phaa.net.au/policyStatementsInterim.php#p (accessed March 18th 2012) 48 Naccarella.L., Buchan, J., and Newton. B., and Brooks, P . 2011. Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad Australian Health Review 35: 262266. www.publish.csiro.au/journals/ahr (accessed March 15th 2012)

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Demand/supply disparities

Attracting and retaining workers to the primary health care sector is a core driver in current workforce reforms. As with the health industry more broadly, primary health care currently struggles with a lack of suitable and skilled workers to fill current roles. A pressing area of concern currently is the registration of Aboriginal and Torres Strait Islander Health Practitioners. Currently there is a gap in the delivery of the Cert IV Aboriginal and Torres Strait Islander Primary Health Care (Practice) qualification which is the requirement for Aboriginal Health Workers to be registered as Practitioners. A number of Registered Training Organisations (RTOs) have this qualification on their scope. The supply is impacted by the capacity of RTOs to meet the requirements of the qualification with problems of funding, appropriately trained staff and clinical placements. There is a need within the sector to attract and then retain workers who understand the philosophy and approach to primary health care broadly, particularly in terms of self-management and care. One critical role the education system has in achieving this need is ensuring that the education system itself prepares the future workforce by integrating the appropriate and changing philosophies of primary health care in its curriculum. Educators will need to play a strong role in developing a future workforce that is not only clinically and technically competent but which also understands the context and aspirations of primary health care and its role in meeting those objectives. In the context of a shift in balance of care from acute to primary care examining the implications for skill mix and identifying areas of skill development required will be vital.49 This is particularly complex given the scope of the primary health care workforce which encompasses not only traditional or clinical health workers. Workers such as personal carers, assistants and support workers, promotion, prevention and early intervention workers and indigenous health workers are a critical part of the overall primary health care sector. In addition to the diversity of the workforce within the sector are the changing expectations of workers about their work and in particular the hours they are prepared to work. Worker preferences are influencing the overall supply as workers opt for fewer hours or more flexible working arrangements.50 Given these complexities strong management and leadership capacity to steer the sector through the current and future changes will be needed. The need for leadership is broadly acknowledged however the value of management is often underrated, and it is this group that has expertise in issues of change management, workforce development and behavioral change.51 To truly transform the delivery of care it is critical to invest in the change management skills required to alter the patient journey, professional roles, funding mechanisms, people and organisational culture.52 Another side to the supply side is that the new jobs created by the Closing the Gap and the Medicare Local policy requiring new clusters of skills for Aboriginal and Torres Strait Islander workforces particularly. There is a need for capacity to be developed particularly for the Closing the Gap workforce, such as the tobacco action workers, healthy life style workers and Indigenous Outreach Workers. Currently, there are no specific career pathways for these positions even though
49 Public Health Association of Australia. 2011. Policy at a glance, primary health care policy. http://www.phaa.net.au/policyStatementsInterim.php#p (accessed March 18th 2012) 50 National Health Workforce Taskforce. 2009. National Health Workforce Taskforce, Health Workforce in Australia and Factors for Current Shortages April 2009. http://www.ahwo.gov.au/documents/NHWT/The%20health%20workforce%20in%20Australia%20and%20factors%20influencing%20current%20shortages.pdf (accessed 16th March 2012) 51 Francis, S., Carswell, P ., North, N., Gauld, R., Brooks, P ., Wakerman, J. 2010. Commentary - Challenging Workforce planning approaches Asia Pacific Journal of Health Management 2010; 5:2 52 Francis, S., Carswell, P ., North, N., Gauld, R., Brooks, P ., Wakerman, J. 2010. Commentary - Challenging Workforce planning approaches Asia Pacific Journal of Health Management 2010; 5:2

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the responsibility for this workforce can be quite complex and in most cases there have only been certain skills sets and orientation programs identified and developed by the Aboriginal Controlled Community Health Services sector to address workforce development. The other major concern for Aboriginal Health Worker workforce is the gap in school-based training delivering health qualifications traineeships/apprenticeships and particularly delivering the Aboriginal and Torres Strait Islander Primary Health Care qualifications. Some of the major problem to date is the capacity of RTOs and schools to establish from scratch the coordination and delivery these qualifications given that lack of experience with the training package HLT 07 for schoolbased qualifications and the commitment and capacity of schools to introduce Health traineeships/ qualifications in general. At the state level there is currently a strong economic outlook driven by a strong resources sector and the consequent workforce demand is having an impact on the primary health care sector workforce.53 This creates competition for staff with the mining sector in some regional areas that are being leaving the sector in pursuit of attractive wages and conditions offered by the mining sector. There is a need for the recognition that a strong primary health care environment is vital for the sustainability of communities. Involving primary health care and the broader health industry in cross-industry and regional economic planning is vital to ensure a coordinated place-based approach that balances competing requirements in the interests of regional communities.

PRIORITIES Develop strategies to increase skills in workforce management of multidisciplinary teams in integrated service models of care and complex service delivery across organisations and institutions. Raise awareness of primary health careers to increase participation and retention of Aboriginal and Torres Strait Islander people in the primary health care workforce Support the leadership capacity of the Aboriginal and Torres Strait Islander health workforce Create capacity to supply increased number of Aboriginal Health Workers to satisfy requirements of the regulatory body Increase the capacity of the education and training sector to deliver Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care Develop industry led initiative which aims to identify the skill mix requirements and consequent skill gaps Implement prolongation and participation programs for the ageing workforce such as re-entry programs, refresher courses, occupational transition, knowledge management programs.

53 Skills Queensland. 2012. Skills and Workforce Development Investment Plan 2012-2013. People Potential Prosperity http://www. skills.qld.gov.au/Functions/Workforce-development/skills-and-workforce-development-investment-plan.aspx#Securingaskilledfuture (accessed May 3rd 2012)

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There is a need for the recognition that a strong primary health care environment is vital for the sustainability of communities

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Advice concerning training product, pathways, training quality and delivery methods

As service delivery changes, there is an increased need for high level skills in workforce management, workforce planning, change management and innovation as services will increasingly be required to adapt to their surroundings as they keep up to date with changing policy and client expectations of the service. Efficiency, cost-effectiveness and return on investment will be increasingly important in the design and delivery of services and workforce models. Flexible, responsive and contemporary education models and pathways which allow mobility within and throughout the health industry and primary health care sector are a significant challenge. There is a need to develop career structures and training pathways for workers that enable career development in the primary health care setting.54 To attract and retain a sustainable health workforce requires multiple entry points to health training and careers, starting at school level with programs that will articulate through the whole education framework.55 There is currently a heavy focus on preparing primary health care students through hospital placements which does not encourage or prepare them to work in the primary health care setting should they choose this path.56 Facilitating a breadth of clinical placements which include the primary health care setting is critical in creating a career pipeline. The tertiary sector needs to support a range of programs, both specialised and general, to meet the range of short course and professional certificate educational needs, preferably within a flexible model that allows articulation with formal qualifications.57 Significant barriers exist between professional disciplines and within training institutions and these impede the ability to further develop and implement a more multi-disciplinary approach and broader scope of practice.58 Within clinical education and training of health professionals, there is a relative lack of interdisciplinary learning opportunities, or horizontal integration of curriculum. A lack of core competency based framework as part of teaching and learning curricula for health workforce has been acknowledged.59 Education reforms attempt to address some of these outlined challenges and issues. These reforms include the Review of Australian Higher Education (2008) which is driving changes in the university sector and integrated package of reforms, Skills for Prosperity a road map for vocational education and training, developed by Skills Australia, the National Skills Body. In early 2012, one of the two Aboriginal community controlled RTO delivering health qualifications, ATSICHET, folded. This has left a significant gap in the capacity of the Queensland training system to deliver the Aboriginal and/or Torres Strait Islander Primary Health Care qualifications. Unfortunately, this is occurring at the same time that theTraining Initiatives for Indigenous Adults in Regional and Remote Communities (TIFIARRC) funding program has been discontinued. There have also been concerns about the quality of delivery of these qualifications in Queensland, and concerns from some of the community controlled sector that some TAFE institutes have been
54 Douglas, K. A., Frith. K., Laurann, L. E., Wells, R. W., Glasgow, N. J., Humphreys, J. S.. 2009. Australias primary health care workforce research informing policy. Medical Journal of Australia Volume 191 Number 2 55 Health Workforce Australia. 2011. National Health Workforce Innovation and Reform Strategic Framework for Action 20112015. https://www.hwa.gov.au/sites/uploads/hwa-wir-strategic-framework-for-action-201110.pdf (accessed April 20th 2012) 56 Commonwealth of Australia. 2009. A healthier future for all Australians - Final Report of the National Health and Hospitals Reform Commission. http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/1AFDEAF1FB76A1D8CA257600000B5BE2/$File/Final_Report_ of_the%20nhhrc_June_2009.pdf (accessed March 3rd 2012) 57 Bennett, C. M., Lilley, K., Yeatman, H., Parker, E., Geelhoed, E., Hanna, E. G., Robinson, P . 2010. Paving Pathways: shaping the Public Health workforce through tertiary education. Australia and New Zealand Health Policy 2010, 7:2 58 Commonwealth of Australia. 2012. National Strategic Framework for Rural and Remote Health. http://www.ruralhealthaustralia.gov. au/internet/rha/publishing.nsf/Content/EBD8D28B517296A3CA2579FF000350C6/$File/NationalStrategicFramework.pdf (accessed March 25th 2012) 59 Commonwealth of Australia. 2009. A healthier future for all Australians - Final Report of the National Health and Hospitals Reform Commission. http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/1AFDEAF1FB76A1D8CA257600000B5BE2/$File/Final_Report_ of_the%20nhhrc_June_2009.pdf (accessed March 3rd 2012)

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delivering the qualifications without Indigenous staff. There is an urgent need to assess the capacity of training providers in Queensland to deliver these qualifications and whether this capacity meets the level of demand. This assessment should include the availability of Aboriginal and/or Torres Strait Islander trainers and viability in the absence of TIFIARRC.

PRIORITIES Expand the scope of clinical training placements to maximize learning opportunities and future career choices in the primary health care sector Clearer articulation of training and career pathways for workers through improved collaboration across education systems Explore more flexible models of delivery of education and training Increase inter-disciplinary learning opportunities and horizontal integration of curriculum Greater use of skill sets to augment current qualifications. Support for regional clusters of service providers, education and training providers and policy-makers to facilitate regional workforce planning, role design and regional training networks. Improve industrys understanding of VET and industrys role in influencing the training system and the training they purchase. including strengthening collaboration stakeholders at the regional level. Explore the capacity for e-learning and e-health in parallel with the roll out of the National Broadband Network. Instigate contemporary learning models to better prepare a workforce for initiating innovation in the emerging policy environment Investigate the capacity of training providers in Queensland to deliver ATSI Primary Health Care qualifications to meet industrys need. This assessment should include the availability of Aboriginal and/or Torres Strait Islander trainers and viability in the absence of TIFIARRC

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KEY ACHIEVEMENTS
Workforce Council continues to support the Health Leaders Group in partnership with key industry, training and government stakeholders committed to seeking innovative solutions to our health workforce crisis. A range of initiatives commenced through the health skills formation strategy continues through funded initiatives and industry partnerships: o Chronic condition self-management o Indigenous health o Health careers promotion o Overseas skilled health professionals o Recognized prior learning o School-based traineeships in health o Health career pathways o Articulation and Recognition to higher education Planning for your Medicare Local Breakfast Seminar o In June the Workforce Council hosted a breakfast seminar exploring the workforce implications of health reforms. o Over 75 representatives from government departments, peak bodies and service providers attended to discuss the workforce implications of the Medicare Locals scheme and the need to integrate strategic workforce planning within the new primary health care structure. o The seminar marked one of the first opportunities for Queensland industry representatives to collectively explore relevant issues. o Focused on the vital need for strategic workforce planning to support the new health reforms, outlining some of the key elements and strategies necessary for such a regional workforce planning process. Outcomes for the seminar included: o Workforce Council has continued engagement with health industry stakeholders, consulting with members of the Health Leaders Group, General Practice Queensland Reference Group, Community Health Services Network Group and Medicare Locals. o The June 2012 Industry Skills Body report will have a stronger emphasis on Primary Health Care and will focus on the workforce skilling and planning needs for the Health Industry in response to the health reforms, e.g. LHHNs and Medicare Locals Health Workforce Leaders Group working with Health Workforce Australia o The Health Workforce Leaders Group established through the Health Skills Formation Strategy 2007-2010 continues to meet together to explore and identify workforce strategies. This is a critical forum in the context of significant change occurring in the health industry as a result of the National Health and Hospital Reforms o In November 2011 the Health Workforce Leaders Group hosted a workshop with over 40 people with the CEO of Health Workforce Australia, Mark Cormack. Rod Camm, CEO of Skills Queensland also attended this workshop. This workshop was open to health industry stakeholders and provided an opportunity to discuss the implementation of national strategies in Queensland.

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Outcomes for the group include: o Workforce Council has continued engaged with health industry leaders across all sectors to support a whole of system approach to workforce planning across Queensland o Strong connections have been established with the National Health Workforce Agency, Health Workforce Australia which will support future planning and implementation of national reform strategies within Queensland o The mechanisms established including the Health Workforce Leaders Group will be accessed by Health Workforce Australia to support their planning Productivity Places Program o Workforce Council has brokered 160 Primary Health Care qualifications to Queensland employers.

Ten Year Skilling and Workforce Development Outlook

Health industry will continue to grow rapidly over the next decade. The industry will continue to experience significant skill and labour shortages, particularly in primary health care. This, in turn will places increased pressure on the training and education sectors, and availability of clinical placements to support training will remain a potential blockage in developing the future health workforce. New technologies and advances in health care will continue to create rapid changes in the nature and complexity of health services. The focus of priority will continue to move toward the community setting and on preventive and primary health services. Significant changes to the structure and funding of key parts of the industry will have significant impact on the work roles and career pathways.

Five Year Skilling Workforce Development Priorities

Design training and development programs to enable new and changed roles and respond to the multiple reforms in the industry. Develop industry led initiative which aims to identify the skill mix requirements and consequent skill gaps Implement prolongation and participation programs for the ageing workforce such as re-entry programs, refresher courses, occupational transition, knowledge management programs. Explore more flexible models of delivery of education and training Increase inter-disciplinary learning opportunities and horizontal integration of curriculum

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 Explore the capacity for e-learning and e-health in parallel with the roll out of the National Broadband Network. Instigate contemporary learning models to better prepare a workforce for initiating innovation in the emerging policy environment Support the development of training capacity in the Aboriginal community controlled health sector and linkages with RTOs.

Priorities for Action Over the Next Year

Increase capacity of the sector to carry out workforce planning based on agreed scope of the primary heath care sector Explore new models which provide for discipline-based workforce development in addition to the more traditional professional based workforce development Increase the provision of training and development in workforce management of multidisciplinary teams in integrated service models of care Increase leadership and change management training and professional development to ensure a capacity to prepare and manage a diverse and flexible workforce Increase provision of training and skills in areas expected to increase in demand into the future including dementia care, counselling and community mental health. Develop strategies to increase skills in workforce management of multi-disciplinary teams in integrated service models of care and complex service delivery across organisations and institutions. Raise awareness of primary health careers to increase participation and retention of Aboriginal and Torres Strait Islander people in the primary health care workforce Support the leadership capacity of the Aboriginal and Torres Strait Islander health workforce Create capacity to supply increased number of Aboriginal Health Workers to satisfy requirements of the regulatory body Increase the capacity of the education and training sector to deliver Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care Expand the scope of clinical training placements to maximize learning opportunities and future career choices in the primary health care sector Develop articulated training and career pathways for workers through improved collaboration across education systems Greater use of skill sets to augment current qualifications. Support for regional clusters of service providers, education and training providers and policy-makers to facilitate regional workforce planning, role design and regional training networks. Improve industrys understanding of VET and industrys role in influencing the training system and the training they purchase. including strengthening collaboration stakeholders at the regional level. Investigate the capacity of training providers in Queensland to deliver ATSI Primary Health Care qualifications to meet industrys need. This assessment should include the availability of Aboriginal and/or Torres Strait Islander trainers and viability in the absence of TIFIARRC.

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Health and Community Services Workforce Council

Health and Community Services Workforce Council Inc.

Ground Floor, 303 Adelaide Street Brisbane QLD 4000 Unit 1, Level 2 390 Flinders Street Townsville QLD 4810

e. info@workforce.org.au w. www.workforce.org.au p. (07) 3234 0190 f. (07) 3234 0474

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