Nurse Practitioner Collaborative Arrangement could be scrapped

Nurse practitioners will be given greater autonomy to prescribe medicine and provide Medicare services without a GP’s sign-off should proposed new laws pass through the Federal Parliament.
 
On Wednesday, the Federal Government introduced legislative changes that would end the Nurse Practitioner Collaborative Arrangement.
 
Currently, nurse practitioners and endorsed midwives are not allowed to autonomously provide services under Medicare or prescribe Pharmaceutical Benefits Scheme (PBS) medicines without the supervision of a medical practitioner.
 
However, if the legislation passes, they will no longer need doctor input before undertaking many of these services.
 
RACGP Vice President Associate Professor Michael Clements told newsGP the decision is disappointing, saying a lot more can be gained by the two professions continuing to work collaboratively.
 
‘We should be looking to build relationships, and looking for opportunities to engage and support each other,’ he said.
 
‘I do think, particularly in the rural and remote context, that doctors and nurse practitioners work best for their patients when we’re working together.
 
‘Having a collaborative arrangement was a way of formalising that relationship so that when we both put our minds to the patient, the working together was a key part of that relationship – it was a key part of that governance.’
 
According to Federal Health and Aged Care Assistant Minister Ged Kearney, the amendment is designed to remove barriers and ‘strike a major blow against the glass ceiling’ holding back nurses.
 
‘Nurse practitioners and midwives work hard to achieve their qualifications and it makes sense to ensure they can work to the full scope of their practice,’ she said.
 
‘Labor’s legislation is about getting the best out of the existing health workforce and attracting more people to the professions.’
 
However, she did not answer a question from newsGP on patient safeguards included in the proposed laws.
 
If passed, the change is ‘not expected to have any direct financial impacts’ and will come into effect on 1 November this year. But the Bill also suggests there could be an ‘indirect financial impact’ as removing a ‘barrier’ to primary care access will likely increase Medicare service provision and PBS prescribing.
 
Currently, there are more than 2200 nurse practitioners in Australia, with the qualification allowing them to practice independently in an advanced and extended clinical role.
 
The plan to scrap the Arrangement has long been called for by the Australian Nursing and Midwifery Federation, with Federal Secretary Annie Butler labelling it a ‘common-sense solution’.
 
‘Removing these unnecessary restrictions, which are completely out of step with international best practice, will allow highly trained nurse partitioners and endorsed midwives to utilise their full set of skills and experience,’ she said.
 
Momentum for change has emerged from the Strengthening Medicare Taskforce and the Nurse Practitioner Workforce Plan, which aims to ‘better utilise nurse practitioners to deliver person-centred care’.
 
An ‘Unleashing the Potential of our Health Workforce’ Scope of Practice independent review is also well underway to better understand medical professionals’ capacity.
 
But Associate Professor Clements believes collaboration should be embedded into any new policy change, with the legislation in its current form representing a step back.
 
‘The emphasis really now does need to be on individuals to work for the best of their patient, using the people around them in collaboration, even though it’s no longer a legal requirement,’ he said.
 
‘The risk that we are concerned about is that this may lead people to entirely independent practice without engagement with other health practitioners, providing a single disease care in isolation from the team.
 
‘That is a risk and we do think the Scope of Practice review needs to think about what’s best for the patient and the team – the concept of scope of practice with the team, rather than scope of practice of an individual.’
 
Instead, the RACGP has backed other plans to better support rural and regional patients while also empowering nurse practitioners.
 
Earlier this month, the Federal Government announced a pilot program to expand the number of nurse practitioners working in GP clinics.
 
Based in South Australia, the Nurse Practitioner Primary Care Pilot will fund six nurse practitioners over the next year to diagnose and treat a wide range of health conditions as part of a multidisciplinary team.
 
This was designed to increase capacity within general practices, with nurses able to assess and diagnose patients, request and interpret tests, prescribe therapies and medications, and receive and make referrals to other health practitioners.
 
Moving forward, Associate Professor Clements is encouraging GPs to continue collaborating with nurse practitioners – and vice-versa – regardless of any future legislative changes.
 
‘It’s worth noting that just because it’s no longer a requirement, doesn’t mean it’s not best practice,’ he said.
 
‘We have a defined relationship where we work off the same medical record, we work as a team, and so even though the legislation is changing, I wouldn’t like to see a change in the relationships that we’ve got right now that are actually working well.’
 
The Bill will be debated in the Federal Parliament at a later date.
 
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