Optimising skill-mix in the primary health care workforce for the care of older Australians

Project Status

Chief Investigators
Nicholas Zwar, Sarah Dennis, Rhonda Griffiths, David Perkins

Associate Investigators
Jenny May, Iqbal Hasan, Gideon Caplan, Mark Harris


Australia has an ageing population and this brings with it demand for more extensive and comprehensive care of chronic disease. Older Australians increasingly demand choice in services and how they are delivered. This is occurring at the same time as the ageing of the primary heath care workforce, changing work practices and workforce shortages. These challenges necessitate a change in the way services are provided in primary care for older people. There is a need for evidence on the potential for optimising the skill-mix to inform policy and to improve the alignment between the needs of older Australians and the skill-mix of the primary health care workforce.

This project will identify the opportunities where optimising the skill-mix of the primary health care workforce will benefit older Australians. This will be done by key informant and stakeholder consultation early in the project to identify the health needs of older Australians that could be addressed by changing skill-mix in the primary health care workforce. This will be followed by a series of focused literature reviews based on best international evidence from the black and grey literature for the most important Australian needs.

In the final phase of the project stakeholders will assist to identify the implications for policy of the findings of the reviews of international evidence and their application in the Australian context. From this a series of policy alternatives will be defined to optimise skill-mix of the primary healthcare workforce to meet the needs of older Australians.


Research Questions

1. What is already known about the priorities for skill-mix changes in the primary health care workforce?

2. What are the needs for the provision of care for older people that could be addressed by changing skill-mix in the primary health care workforce?

3. How are these needs affected by context including remote, rural, outer metropolitan, and urban? Issues for groups with special needs such indigenous or non-English speaking Australians will be examined in each of these setting.

4. What do the stakeholders believe are the skill-mix changes required to meet these needs?

5. What does the literature tell us about the optimal skill-mix to meet the needs as identified in questions 1 to 4?

6. What information is there on the cost effectiveness of these skill-mix changes?

7. How are the effective solutions applicable in the Australian context? This will consider how systems of pay/reimbursement in primary care and state/federal regulations governing scope of practice/licensing of various health professions are likely to constrain what can be done in terms of skill-mix change.

8. What are the policy options and investments necessary to implement the solution as identified in question six.

Design and Method

A systematic review of the evidence

Key Publications

Zwar N, Dennis S, Griffiths R, Perkins D, May J, Sibbald B, et al. Optimising skill mix in the primary health care workforce for the care of older Australians: A systematic review. Canberra: Australian Primary Health Care Research Institute (APHCRI); 2007. http://www.anu.edu.au/aphcri/Domain/Workforce/Zwar_1_final.pdf