Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners

Abstract

Participation of allied health professionals (AHP) in the Enhanced Primary Care (EPC) program is increasing. However, access to allied health services is strictly delineated under the EPC program and AHP face unique practice realities in providing care to patients with chronic conditions. This paper examines the discretionary practices adopted by AHP in response to the realities at the policy-practice interface and situates the discussion within a description of their experiences with EPC. Semistructured telephone interviews were conducted with a purposive sample of fifteen AHP. Participants were selected from a larger cohort who responded to a questionnaire about EPC. The EPC program was perceived as a positive start, although some aspects were problematic. Participants reported that the restriction on the number of subsidised sessions was not conducive to providing a good allied health service to patients with complex care needs and remuneration was not commensurate with the nature and scope of treatment required. The AHP in this study spoke of the dilemma of wanting to assist patients but at the same time to operate a financially viable business. Moreover, their experience was that multidisciplinary team care was implied rather than reality. Abbreviated care practices, reasonable solutions for access, and entrepreneurial practices were strategies used to manage the policy-practice tensions.