Table 6 Narrative of the MPA Program
Need Workforce shortages in rural and remote health care delivery pose a persistent issue across Australia and can result in suboptimal and high-cost care, particularly in respect to primary practice. Skill shortages, retention issues, smaller staff numbers and a broad range of non-specialised tasks being undertaken by specialist roles, can lead to longer wait times and shorter consult times for patients, and increased costs to the practice. Various initiatives have been implemented to increase numbers and retention of health care providers and improve efficiencies in health care delivery. Optimising GP and PN time and supporting them to work at the top of their scope are critical to increasing efficiencies, improving cost effectiveness and enhancing patient care. Additionally, evaluation (including economic and impact assessment) is critical to optimizing the outcomes and impacts of such initiatives and inform future programs accordingly |
Program response To address these needs, the Hunter New England and Central Coast Primary Health Network (HNECC PHN) implemented an initiative to upskill general practice administrative staff (mainly receptionists or practice managers) in a range of appropriate clinical and high-end administrative tasks. The aims of the initiative included: broadening the scope of practice managers and practice administration staff, building health workforce capability, reducing the impact of skill shortages in primary practice, boosting productivity within practices through more cost-effective delivery of clinical services, increasing job and role satisfaction for practice staff and ensuring roles are working at the top of their skill level and qualifications. The HNECC PHN entered into an arrangement with UNE Partnerships—an entity certified to deliver the MPA Course; engaged practices to encourage their administrative staff to undertake an MPA Certificate (Cert IV) and provide the required on-the-job supervision; subsidised course fees for administrative staff from local general practices and Aboriginal medical services to undertake the MPA Cert IV, and coordinated and resourced regular MPA Conferences to facilitate learnings from the initiative, created a network of MPA practitioners in the region and have contributed to efforts to have the MPA role officially recognised and a recognised national award created for medical practice assistants |
Program outcomes Whilst the program initiatives and the full impact of the MPA program is yet to be fully realised, a multitude of desired outcomes have been achieved. Forty four students have graduated from the MPA course (as of 1 June 2021) as more highly skilled practice staff, 62 general practices have been recruited into the program initiative in 2018 and 2019, 62 scholarships have been granted to general practice staff in the region, MPA program expression of interest processes have been established, along with a growing network of graduates. Additional support packages for Aboriginal MPA students and a series of new resources and further development opportunities have been provided (i.e., webinars, conferences etc.), including pathways to accrue continuing professional development (CPD) points. A University of New England (UNE) booklet has been produced and progress towards establishing new practice roles and award rates for MPA qualified administrators is underway |
Impact The program initiative has been successful in generating a range of economic, knowledge, capacity building, practice, staff and community and patient impacts, as evidenced in the Payback metrics (Table 3). Most significantly, the program has resulted in greater work satisfaction for practice staff, and improved ability of practices to provide better patient care. GPs and PNs reported greater work satisfaction, GPs reported an increase in resources to provide patient care and PNs reported less stress and reduced workloads. MPA graduates felt the course had benefitted them professionally and personally with 80% reporting higher job satisfaction and confidence and being able to fill in for a PN when required. Other benefits included increased knowledge, increased hours and pay, more variety and capacity in work tasks, improved relationships with colleagues and patients as exemplified by one graduate “my relationships with other staff have been better as I understand everything a lot more and I can help everyone out” Graduates also reported the ability to work at a higher level (“I get to do more things now”) get more hours of work compared to previously, and “enjoying the challenge and finding it more satisfying” Additionally, MPA graduates felt they had personally gained new perspectives and that this knowledge was also beneficial in their personal lives e.g., enabling assistance with family members’ health and having “a lot more confidence with my grandkids if they are unwell” Critically, undertaking the MPA has sufficiently built their confidence to undertake further tertiary studies- primarily in health care: “Since completing the course it has given me confidence to go further with my studies”. Forty five percent have gone on to study nursing, social work, practice management and paramedicine. This is important for reducing skill shortages in the region and creating progressive career pathways that further add to job satisfaction, ultimately aiding in retention of skilled staff in rural and regional areas Positive impacts of the program were also seen within practices, “Having a MPA has been a valuable asset throughout our entire practice” as demonstrated through the cost and time efficiencies gained by practices not requiring additional temporary fill in staff when their existing staff are unwell or on leave. MPA graduates were able to provide sufficient coverage: “On days when we are short of nurses our MPA is able to contribute to our workload with being able to triage, complete sterilization and assist GPs with procedures” Practices also benefitted through more effective use of PN and GP time, value adding and improving productivity “our MPA has been very beneficial to our clinical area leaving more time for registered nurses to deal with more urgent situations on the day”. They have also allowed streamlining of tasks and responsibilities: “…we have our MPA assist with diabetes clinics”, reducing key bottlenecks and through associated flow-on positive impacts on other practice staff and patients “By helping out with the extra duties, it has taken the pressure off the nursing staff” “They are a really great resource to reduce workload and stress of nursing staff -this helps our treatment room RN with the waiting time for patients” Improving practice staff capacity and knowledge and reducing staff stress has additional flow on benefits for patients and the broader community. For this study patient surveys were not undertaken, however feedback was provided by practice staff regarding their perspectives on improved patient care. Survey and interviews revealed that patients of practices with an MPA graduate, experienced reduced waiting times, improved care, and seamless continuity of care—“we are able to offer a better health outcome and continuation of care as a result of improved patient rapport and more meaningful engagement between staff, leading to better health outcomes for patients.” Another reported “patients have had one on one time with me and have commented on how lovely it is to see me out in the nurses’ station” while another said “having a broader knowledge base and being able to relate that to the patient and making them more at ease. It extends their contact time with someone while they are in the clinic”. Shorter wait times and less seemingly rushed consultations, result in greater patient satisfaction, improved triage and patient care, and reduce risks of cross patient infection Overall, despite the short lag time between MPA graduation and this survey (only 22 graduates back working in the practice post-graduation) the HNECC PHN initiative has had significant impact for the limited number of graduates and practices included in the assessment. Whilst the program is new and still being refined, demonstrable impact has already been realised and captured through this assessment The most significant impact of the MPA program in this cohort is the increase in job satisfaction of broader practice staff- including practice managers, GPs and PNs in addition to MPA graduates. Job satisfaction is a key pillar in rural and remote workforce retention and the flow on effects of introducing tertiary study to the existing workforce and encouraging further upskilling and study has promising implications for further growing and retaining the health workforce in the Hunter, New England and Central Coast regions of NSW but also holds promise for other rural and regional locations in Australia |