Roles of health professionals are still unfortunately often stuck in the past. That is, before the shift of education of nurses and other health professionals into universities in the 1980s. So many are still not working to their full scope of practice.

There has been some expansion of roles in recent years – including pharmacists prescribing (under limited circumstances) and administering a wider range of vaccinations.

But the recently released paper from an independent Commonwealth review on health workers’ “scope of practice” identifies the myriad of barriers preventing Australians from fully benefiting from health professionals’ skills.

These include workforce design (who does what, where and how roles interact), legislation and regulation (which often differs according to jurisdiction), and how health workers are funded and paid.

There is no simple quick fix for this type of reform. But we now have a sensible pathway to improve access to care, using all health professionals appropriately.

A new vision for general practice

I recently had a COVID booster. To do this, I logged onto my general practice’s website, answered the question about what I wanted, booked an appointment with the practice nurse that afternoon, got jabbed, was bulk-billed, sat down for a while, and then went home. Nothing remarkable at all about that.

But that interaction required a host of facilitating factors. The Victorian government regulates whether nurses can provide vaccinations, and what additional training the nurse requires. The Commonwealth government has allowed the practice to be paid by Medicare for the nurse’s work. The venture capitalist practice owner has done the sums and decided allocating a room to a practice nurse is economically rational.

The future of primary care is one involving more use of the range of health professionals, in addition to GPs.

It would be good if my general practice also had a physiotherapist, who I could see if I had back pain without seeing the GP, but there is no Medicare rebate for this. This arrangement would need both health professionals to have access to my health record. There also needs to be trust and good communication between the two when the physio might think the GP needs to be alerted to any issues.

This vision is one of integrated primary care, with health professionals working in a team. The nurse should be able to do more than vaccination and checking vital signs. Do I really need to see the GP every time I need a prescription renewed for my regular medication? This is the nub of the “scope of practice” issue.

How about pharmacists?

An integrated future is not the only future on the table. Pharmacy owners especially have argued that pharmacists should be able to practise independently of GPs, prescribing a limited range of medications and dispensing them.

This will inevitably reduce continuity of care and potentially create risks if the GP is not aware of what other medications a patient is using.

But a greater role for pharmacists has benefits for patients. It is often easier and cheaper for the patient to see a pharmacist, especially as bulk billing rates fall, and this is one of the reasons why independent pharmacist prescribing is gaining traction.

Every five years or so the government negotiates an agreement with the Pharmacy Guild, the organisation of pharmacy owners, about how much pharmacies will be paid for dispensing medications and other services. These agreements are called “Community Pharmacy Agreements”. Paying pharmacists independent prescribing may be part of the next agreement, the details of which are currently being negotiated.

GPs don’t like competition from this new source, even though there will be plenty of work around for GPs into the foreseeable future. So their organisations highlight the risks of these changes, reopening centuries old turf wars dressed up as concerns about safety and risk.

Who pays for all this?

Funding is at the heart of disputes about scope of practice. As with many policy debates, there is merit on both sides.

Clearly the government must increase its support for comprehensive general practice. Existing funding of fee-for-service medical benefits payments must be redesigned and supplemented by payments that allow practices to engage a range of other health professionals to create health-care teams.

This should be the principal direction of primary care reform, and the final report of the scope of practice review should make that clear. It must focus on the overall goal of better primary care, rather than simply the aspirations of individual health professionals, and working to a professional’s full scope of practice in a team, not a professional silo.

In parallel, governments – state and federal – must ensure all health professionals are used to their best of their abilities. It is a waste to have highly educated professionals not using their skills fully. New funding arrangements should facilitate better access to care from all appropriately qualified health professionals.

In the case of prescribing, it is possible to reconcile the aspirations of pharmacists and the concerns of GPs. New arrangements could be that pharmacists can only renew medications if they have agreements with the GP and there is good communication between them. This may be easier in rural and suburban areas, where the pharmacists are better known to the GPs.

The second issues paper points to the complexity of achieving scope of practice reforms. However, it also sets out a sensible path to improve access to care using all health professionals appropriately.

Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Olympian Tom Daley is the most decorated diver in Britain’s history. He is also an avid knitter. At the Paris 2024 Olympics Daley added a fifth medal to his collection – and caught the world’s attention knitting a bright blue “Paris 24” jumper while travelling to the games and in the stands.

At the Tokyo Olympics, where Daley was first spotted knitting, he explained its positive impact on his mental health.

It just turned into my mindfulness, my meditation, my calm and my way to escape the stresses of everyday life and, in particular, going to an Olympics.

The mental health benefits of knitting are well established. So why is someone famous like Daley knitting in public still so surprising?

Knitting is gendered

Knitting is usually associated with women – especially older women – as a hobby done at home. In a large international survey of knitting, 99% of respondents identified as female.

But the history of yarn crafts and gender is more tangled. In Europe in the middle ages, knitting guilds were exclusive and reserved for men. They were part of a respected Europe-wide trade addressing a demand for knitted products that could not be satisfied by domestic workers alone.

The industrial revolution made the production of clothed goods cheaper and faster than hand-knitting. Knitting and other needle crafts became a leisure activity for women, done in the private sphere of the home.

World Wars I and II turned the spotlight back on knitting as a “patriotic duty”, but it was still largely taken up by women.

During COVID lockdowns, knitting saw another resurgence. But knitting still most often makes headlines when men – especially famous men like Daley or actor Ryan Gosling – do it.

Men who knit are often seen as subverting the stereotype it’s an activity for older women.

Knitting the stress away

Knitting can produce a sense of pride and accomplishment. But for an elite sportsperson like Daley – whose accomplishments already include four gold medals and one silver – its benefits lie elsewhere.

Olympics-level sport relies on perfect scores and world records. When it comes to knitting, many of the mental health benefits are associated with the process, rather than the end result.

Daley says knitting is the “one thing” that allows him to switch off completely, describing it as “my therapy”. https://www.youtube.com/embed/6wwXGOki–c?wmode=transparent&start=0

The Olympian says he could

knit for hours on end, honestly. There’s something that’s so satisfying to me about just having that rhythm and that little “click-clack” of the knitting needles. There is not a day that goes by where I don’t knit.

Knitting can create a “flow” state through rhythmic, repetitive movements of the yarn and needle. Flow offers us a balance between challenge, accessibility and a sense of control.

It’s been shown to have benefits relieving stress in high-pressure jobs beyond elite sport. Among surgeons, knitting has been found to improve wellbeing as well as manual dexterity, crucial to their role.

For other health professionals – including oncology nurses and mental health workers – knitting has helped to reduce “compassion fatigue” and burnout. Participants described the soothing noise of their knitting needles. They developed and strengthened team bonds through collective knitting practices. https://www.youtube.com/embed/dTTJjD_q2Ik?wmode=transparent&start=0 A Swiss psychiatrist says for those with trauma, knitting yarn can be like “knitting the two halves” of the brain “back together”.

Another study showed knitting in primary school may boost children’s executive function. That includes the ability to pay attention, remember relevant details and block out distractions.

As a regular creative practice, it has also been used in the treatment of grief, depression and subduing intrusive thoughts, as well countering chronic pain and cognitive decline.

Knitting is a community

The evidence for the benefits of knitting is often based on self-reporting. These studies tend to produce consistent results and involve large population samples.

This may point to another benefit of knitting: its social aspect.

Knitting and other yarn crafts can be done alone, and usually require simple materials. But they also provide a chance to socialise by bringing people together around a common interest, which can help reduce loneliness.

The free needle craft database and social network Ravelry contains more than one million patterns, contributed by users. “Yarn bombing” projects aim to engage the community and beautify public places by covering objects such as benches and stop signs with wool.

The interest in Daley’s knitting online videos have formed a community of their own.

In them he shows the process of making the jumper, not just the finished product. That includes where he “went wrong” and had to unwind his work.

His pride in the finished product – a little bit wonky, but “made with love” – can be a refreshing antidote to the flawless achievements often on display at the Olympics.

Michelle O’Shea, Senior Lecturer, School of Business, Western Sydney University and Gabrielle Weidemann, Associate Professor in Psychological Science, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.