Table 1 Summary of scenarios used in the model
Sub-models | Scenario | Description | Rationale/source | Measures | Policy or non-policy scenarioa | Scenario impact in 2033b |
|---|---|---|---|---|---|---|
Need and Supply | 1. Base scenario | Uses base year data—2003/04 Projections commence 2013 No changes except annual increase in level of service and population changes | Various (see [20] for details) | Various (see [20] for details) |  |  |
Need | 2. Reduced illness of the population | Changes in population incidence and prevalence of disease. | Vos et al [32] and Goss [33] predicted changes in incidence and prevalence for selected injuries and illnesses. | Changes in estimated prevalence/incidence levels from base year Three changes estimated for years 2013, 2023 and 2033 | Non-policy | −3.35% less need |
3. Increased role substitution | Increased use of practice nurse in GP consultations. | Bettering Evaluation and Care of Health (BEACH) data on proportion of consultations/conditions managed where nurse involved [44]. In 2010–11, 9% of all encounters involved a practice nurse in patient care. | 10% of all estimated GP consultations undertaken by practice nurses. | Policy | −10.00% less need | |
4. Increased Prevention | Change in preventive consultations as proportion of all consultations | Over 50% of GP consultations are for the management of chronic diseases and this is increasing [45]. A number of key strategies support increased preventative activity such as screening, immunisation and health checks [46, 47]. | A 5% increase in the proportion of prevention consultations | Policy | 0.05% more need | |
5. Increased visits to the GP | Change in average number and length of consultations. | Average number and length of consultations is an important measure of need. Changes in utilisation can result from the introduction of new Medicare items [48] or influenced by the attributes of the GPs [49]. | 5% increase in average length of consultations by age/sex and 2011–12 estimates of average number of consultations from FMRC customised analysis. | Non-policy | 7.36% more need | |
Supply | 6. Increased GP training places | Increase in number of GP training places. | GP training positions has a direct impact on workforce supply. | SA proportion of an increase in 500 training positions nationally between 2015 and 2033 based on historic rates. | Policy | 5.04% more supply |
7. Reduced Participation | Change in proportion of GP stock working full or part-time. | AIHW Medical Labour Force Survey shows that between 1999 and 2009, the number of hours worked by GPs fell from 45.6 to 42.2 per week [50]. Working hours have declined more for male GPs (by 7.4%) than for female GPs (6.4%) [13] | A 25% increase in the number of urban full-time male GPs who move to part-time work. | Non-policy | −0.90% less supply | |
8. Reduced IMG recruitment | Decrease in number of IMGs entering the workforce for rural SA | Government goal from 2004 is national self-sufficiency and less reliance on immigration as a workforce strategy [40]. | Change in IMGs entering rural GP by age, sex and work status by 25% from 2014 | Policy | −6.29% less supply |