1. New Workforce-based Models of Primary Care and an evaluation of the quality of evidence underpinning them Professor Deborah Schofield Chair of Health Economics, NHMRC Clinical Trials Centre and School of Public Health, Sydney Medical School, University of Sydney Dr Lucio Naccarella NHMRC Postdoctoral Training Fellow, The Australian Health Workforce Institute, The University of Melbourne and General Practice Victoria 13th International Health Workforce Collaborative Conference October 24-26, 2011, Brisbane, Australia

2. Remembering Our Elders “Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world” Albert Einstein (18-12-1932 to 10–06-2011)

3. Context Strengthening primary care by extending workforce roles and skills within health systems is one way to meet the increasing demands upon the health system Essential to assess the available evidence for each new or revised workforce-based models of primary care, and to conduct well designed rigorous evaluations

4. Paper Objectives 1.Models of primary care using different workforce arrangements 2.Framework for assessing evidence about models of primary care 3.Evaluate the quality of evidence in relation to models of diabetes care in the primary care setting

5. Primary Care Workforce Model Typology Innovation Supplementation/ enhancement Substitution/delegation

6. Framework for assessing the quality of evidence Relevant and replicable Theoretical framework Strength of the evidence Size of the effect Transferability and representative Duration Value for money

8. Evidence of Workforce Models Models of Diabetes CareWorkforce Models– roles, skills mix… Point of care testing Shephard et al(2005) local GP, diabetes educator, podiatrist Diabetes model of care – WA (2008) GP-coordinated multidisciplinary approach ? Pharmacy diabetes care Krass et al (2007) Pharmacists POCT Shephard (2006) Clinical staff, aboriginal health care workers, allied health professionals Greater green triangle diabetes prevention project Laatikainen et al (2007) and Kilkkinen et al (2007) Nurses, dietician, physiotherapist Enhanced primary care Foster et al (2008) GPs, allied health professional Chronic disease management in primary care Dennis et al (2008) Multidisciplinary team care?

9. Discussion Policy directions are: – Supporting & strengthening a well-trained multidisciplinary team- based primary care workforce – Piloting new approaches for the delivery of PHC services Coordinated Care for Diabetes Pilot in the primary care setting BUT…. Review revealed need for higher standard of evidence about the merits of models of primary care. – Limited representativeness & replicability – No study included assessment of cost effectiveness And… – Limited evidence about workforce models - roles & skills mix

10. In Conclusion Proliferation of new models of primary care in Australia + new workforce roles & skills mix Need for more robust studies to assess whether: – interventions are effective in producing improved health outcomes – effective interventions represent value for money Need for more evidence about workforce models of primary care -> sustainability

11. Thank You “The intuitive mind is a sacred gift and the rational mind is the faithful servant. We have created a society that honours the servant and has forgotten the gift” Albert Einstein Source Wade Davis (2009) The Wayfinders: why ancient wisdom matters in the modern world. Chapter 4: Sacred Geography