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.

Toddler milk is popular and becoming more so. Just over a third of Australian toddlers drink it. Parents spend hundreds of millions of dollars on it globally. Around the world, toddler milk makes up nearly half of total formula milk sales, with a 200% growth since 2005. Growth is expected to continue.

We’re concerned about the growing popularity of toddler milk – about its nutritional content, cost, how it’s marketed, and about the impact on the health and feeding of young children. Some of us voiced our concerns on the ABC’s 7.30 program recently.

But what’s in toddler milk? How does it compare to cow’s milk? How did it become so popular?

What is toddler milk? Is it healthy?

Toddler milk is marketed as appropriate for children aged one to three years. This ultra-processed food contains:

• skim milk powder (cow, soy or goat)
• vegetable oil
• sugars (including added sugars)
• emulsifiers (to help bind the ingredients and improve the texture)

• added vitamins and minerals.

Toddler milk is usually lower in calcium and protein, and higher in sugar and calories than regular cow’s milk. Depending on the brand, a serve of toddler milk can contain as much sugar as a soft drink.

Even though toddler milks have added vitamins and minerals, these are found in and better absorbed from regular foods and breastmilk. Toddlers do not need the level of nutrients found in these products if they are eating a varied diet.

Global health authorities, including the World Health Organization (WHO), and Australia’s National Health and Medical Research Council, do not recommend toddler milk for healthy toddlers.

Some children with specific metabolic or dietary medical problems might need tailored alternatives to cow’s milk. However, these products generally are not toddler milks and would be a specific product prescribed by a health-care provider.

Toddler milk is also up to four to five times more expensive than regular cow’s milk. “Premium” toddler milk (the same product, with higher levels of vitamins and minerals) is more expensive.

With the cost-of-living crisis, this means families might choose to go without other essentials to afford toddler milk.

How toddler milk was invented

Toddler milk was created so infant formula companies could get around rules preventing them from advertising their infant formula.

When manufacturers claim benefits of their toddler milk, many parents assume these claimed benefits apply to infant formula (known as cross-promotion). In other words, marketing toddler milks also boosts interest in their infant formula.

Manufacturers also create brand loyalty and recognition by making the labels of their toddler milk look similar to their infant formula. For parents who used infant formula, toddler milk is positioned as the next stage in feeding.

How toddler milk became so popular

Toddler milk is heavily marketed. Parents are told toddler milk is healthy and provides extra nutrition. Marketing tells parents it will benefit their child’s growth and development, their brain function and their immune system.

Toddler milk is also presented as a solution to fussy eating, which is common in toddlers.

However, regularly drinking toddler milk could increase the risk of fussiness as it reduces opportunities for toddlers to try new foods. It’s also sweet, needs no chewing, and essentially displaces energy and nutrients that whole foods provide.

Growing concern

The WHO, along with public health academics, has been raising concerns about the marketing of toddler milk for years.

In Australia, moves to curb how toddler milk is promoted have gone nowhere. Toddler milk is in a category of foods that are allowed to be fortified (to have vitamins and minerals added), with no marketing restrictions. The Australian Competition & Consumer Commission also has concerns about the rise of toddler milk marketing. Despite this, there is no change in how it’s regulated.

This is in contrast to voluntary marketing restrictions in Australia for infant formula.

What needs to happen?

There is enough evidence to show the marketing of commercial milk formula, including toddler milk, influences parents and undermines child health.

So governments need to act to protect parents from this marketing, and to put child health over profits.

Public health authorities and advocates, including us, are calling for the restriction of marketing (not selling) of all formula products for infants and toddlers from birth through to age three years.

Ideally, this would be mandatory, government-enforced marketing restrictions as opposed to industry self-regulation in place currently for infant formulas.

We musn’t blame parents

Toddlers are eating more processed foods (including toddler milk) than ever because time-poor parents are seeking a convenient option to ensure their child is getting adequate nutrition.

Formula manufacturers have used this information, and created a demand for an unnecessary product.

Parents want to do the best for their toddlers, but they need to know the marketing behind toddler milks is misleading.

Toddler milk is an unnecessary, unhealthy, expensive product. Toddlers just need whole foods and breastmilk, and/or cow’s milk or a non-dairy, milk alternative.

If parents are worried about their child’s eating, they should see a health-care professional.

Anthea Rhodes, a paediatrician from Royal Children’s Hospital Melbourne and a lecturer at the University of Melbourne, co-authored this article.

Jennifer McCann, Lecturer Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University; Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University, and Naomi Hull, PhD candidate, University of Sydney

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