Most managers of public mental health services reported a perceived migration of psychologists from the public sector to the private sector as a result MBS funding availability through the Better Access initiative. The shift, where it was reported, was not as great as expected, and a consistent view of psychology organisations and several state and territory health departments was that, where it occurred, it was primarily a move towards a mix of public and private practice. From consultations across states and territories it appeared to the evaluators that representatives from smaller jurisdictions were reporting a more pronounced shift than those from the larger states.
A concern across public providers and psychology organisations was that this shift, where occurring, was most likely to be in the more senior positions and that this may have a longer term impact on the capacity to provide training and supervision to trainee psychologists entering the workforce. It was suggested by several organisations that there may be a need to consider new employment arrangements incorporating private practice for psychologists and shared training arrangements across the public and private sector – similar to that in place for the medical workforce. Public mental health providers reported very little, if any, shift in employment practices for occupational therapists and social workers.
There were comments from the small area consultations and consultations with AHP representative bodies that the Better Access initiative may be having an impact on the distribution of the allied health workforce in private practice. This was identified as occurring at three levels:
- responding to capacity to attract gap payments, there may be a relocation of providers to more affluent areas where higher fees can be charged;
- the MBS payments have provided the ability for AHPs to establish practices in areas that would not otherwise be financially viable; and
- new service models are developing with AHPs co-locating with GP practices to provide a more comprehensive service and facilitate cross referral.
A potentially more serious unintended impact of the Better Access initiative reported by GPs in remote rural areas may be the capacity to recruit AHPs to ATAPS and MAHS in remote areas and/or challenging communities. One remote area reported that the cost of sessional payments by psychologists through ATAPS had doubled to match the MBS rebate to clinical psychologists, and two reported that it was more difficult to attract staff.