A bill introduced today would allow nurse practitioners and endorsed midwives to prescribe through the PBS and to bulk bill without doctor supervision.
A new bill introduced into federal parliament today would repeal the “unpopular” medical supervision of nurse practitioners and endorsed midwives by physicians, allowing them to prescribe through the PBS and bill for services through the MBS.
According to the DoHAC, the Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill, if passed, would improve access to “top quality care” from NPs and endorsed midwives, especially in thin markets such as rural and remote areas.
The proposal has, unsurprisingly, been welcomed with open arms by midwife and nurse representatives.
The Australian College of Midwives said the legislation would remove “unnecessary red tape” by repealing the “unpopular” collaborative arrangement requirements and removing “medical gate-keeping”.
“There has been a requirement for a midwife to enter into an agreement with a doctor, which effectively, was at the discretion of the doctor,” ACM’s Chief Midwife Alison Weatherstone said.
“Midwives work to their scope of practice and are required to consult and refer to obstetricians and other medical practitioners as needed.
“They do not need this extra paperwork in place to work effectively with doctors.”
The sentiments were echoed by Australian Primary Health Care Nurses Association president Karen Booth who labelled the move to remove the “restrictive” arrangements a “great start”, at this morning’s briefing in Canberra.
“The healthcare system is struggling to meet demand and it is appropriate for governments to explore and implement new models of care.
“Our healthcare system relies on highly skilled and trusted nurses, and this legislation today follows the lead from the success of ACT and Tasmanian nurse-led walk-in clinics.”
Australian Nursing and Midwifery Federation federal secretary Annie Bulter added her support for the removal of the “outdated” and “unnecessary” requirement that she deemed “completely out of step with international best practice”.
The proposed changes follow the findings of “an independent review” that collaborative arrangement “create several barriers to accessible, high-quality care for patients, particularly in rural and remote communities”.
The proposed bill comes after the release of the first issues paper from the independent Scope of Practice Review in January but precedes the final report which is scheduled to be released at the end of 2024.
The government is currently running a consultation into NP and endorsed midwife prescribing which is due to close on 1 April.
Speaking to Health Service Daily a RANZCOG spokesperson said the college looked forward to submitting to the consultation and that “any decisions or changes that are made should be informed by review, to ensure the best outcome for women and their families”.
RANZCOG added that while it was appropriate in some cases for NPs and midwives to prescribe some medicines, and should “not be restricted by structural barriers”, “NPs and midwives should not be treated as direct substitutes for medical doctors – in this case specialists in O&G or GP-obstetricians”.
The expansion of scope of practice has been a recurrent concern for doctors, particularly regarding expanded prescribing rights.
Both the AMA and the RACGP spoke out against autonomous nurse practitioner prescribing in response to a proposal from the Nursing and Midwifery Board of Australia mid-last year, citing patient safety and fragmented care concerns.
Part of the bill’s proposed changes stem from the Nurse Practitioner Workforce Plan committed to by the government in May of last year.
The plan proposed NP-led prescribing and bulk billing with fewer limitations by 2026 and was contested by AMA president Professor Steve Robson who told HSD’s sister publication The Medical Republic at the timethat the association did not agree with releasing nurse practitioners from collaborative agreements.
Should the bill pass, it would take effect as of 1 November this year.