One man’s red tape is another man’s robust clinical governance framework.
From Friday 1 November, nurse practitioners and midwives will no longer have to be linked with a doctor in order to access MBS and PBS rebates for their patients.
While nurse practitioner representatives say nothing will change clinically, doctor groups warn that the move will fragment care further.
Marking the incoming change today, Health Minister Mark Butler and Assistant Health Minister Ged Kearney were of the view that removing collaborative arrangements would cut back “red tape” for nurse practitioners.
“This is a wonderful announcement,” Ms Kearney said.
“This really opens up the doors for endorsed wives and nurse practitioners to operate independently, to set up their own small businesses, to provide very best care to the community that we possibly can.
“It’s great news for the community because it means increased access to healthcare at a time when we know that many people are struggling to get timely healthcare, particularly in our rural and regional areas, but also here in our cities.”
Mr Butler, meanwhile, called collaborative arrangements “unfinished business” and said increasing the number of nurse practitioners in Australia was part of a “big plan” to tap into the workforce.
“We have recognised, after an independent review provided clear evidence that those collaborative arrangements have really no place in our system and should be abolished, which is why we were so proud to get legislation through the Australian Parliament to get rid of that,” he said.
“We’re also lifting the Medicare rebates that nurse practitioners can claim for general consults, we lifted them by 30% to ensure there’s a financial viability for nurse practitioners who want to build their own businesses to be able to deliver healthcare in cities like this, but importantly, also in rural and regional Australia.”
Under collaborative agreements, which have been in place since 2010, nurse practitioners and midwives would have a written agreement with a doctor defining their scope of practice, prescribing arrangements and circumstances in which they would consult with that doctor, refer to that doctor or transfer care to that doctor.
These agreements could cover care for specific patients or for a range of services provided by one nurse practitioner.
Alternatively, rather than a written agreement, nurse practitioners could seek acknowledgement from a doctor that they will be collaborating in the care of a patient or patients, so long as they explain that to each patient and keep individual notes as required by regulation 8 of the Health Insurance Act.
Nurse practitioners who were employed by a doctor or medical practice, or had a patient referred to them in writing, were considered to have collaborative arrangements in place.
Without an agreement in place, nurse practitioners and midwives could still practice but would have to bill privately.
Australian College of Nurse Practitioners CEO Associate Professor Leanne Boase told The Medical Republic that the removal of collaborative arrangements would not increase scope of practice.
“After tomorrow, there’ll be absolutely no change in the way that nurse practitioners or midwives practice,” she said.
“There’s no increase to the scope of practice.
“There’s no change in the level of oversight from what we’ve always had.
“It’s simply that the financial requirements for administration of patient subsidies is changing, and that’s the only change.”
Professor Boase said collaborative arrangements had been misinterpreted “since the day it was implemented” and used as an “attempted means of control”, which was why it was being removed.
“The requirement for a collaborative arrangement meant more administration to access rebates, but now we won’t have to do that,” she said.
“It removes a time burden on practitioners, but it also means fewer private consultations without rebates and fewer private prescriptions, which is good for access to healthcare.”
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AMA president Dr Danielle McMullen rejected the narrative that collaborative arrangements weren’t part of a strong clinical governance framework.
“We’ve said time and time again, as the AMA, that when we’ve got other health practitioners working at expanded scopes, that needs to be part of a team,” she told TMR.
“And what these collaborative arrangements did was formalise that team.”
Australians deserve a coordinated system, Dr McMullen said.
“Nurse practitioners can be a valuable part of the workforce … but we always need a doctor involved for either the tricky cases, when things go pear-shaped, or to be part of the team making sure patients are getting that broad breadth of scope involvement in their care,” she said.
The move to undo nurse practitioner and midwife collaborative care arrangements was separate to the scope of practice review.
The final report on scope of practice was handed to the Health Ministers earlier this month.
This story was amended on 1 November 2024 with a more comprehensive overview of nurse practitioner collaborative arrangements.
