AMA, RACGP object to feds’ move to drop ‘medical gate-keeping’

5 minute read

A bill introduced today would allow nurse practitioners and endorsed midwives to prescribe through the PBS and bulk bill without doctor supervision.

The AMA and RACGP are unhappy about a new bill introduced into federal parliament today which would repeal the “unpopular” collaborative arrangement between nurse practitioners and endorsed midwives, and physicians. 

Today, the Albanese government introduced a the bill which, if passed, will remove the requirement for NPs and endorsed midwives to be under medical practitioner supervision in order 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 aims to improve access to “top quality care” from nurse practitioners and endorsed midwives, especially in rural and remote areas which can be subject to greater access inequity. 

The expansion of scope of practice has been a recurrent concern for doctors, particularly regarding expanded prescribing rights. 

Both the RACGP and AMA spoke out against autonomous NP prescribing in response to a proposal from the Nursing and Midwifery Board of Australia mid-last year, citing patient safety and fragmented care concerns

Speaking to The Medical Republic, president of the AMA, Professor Steve Robson said the association was “greatly disappointed” by the government’s plan and had written to the federal health minister to urge him to reconsider. 

“The AMA is on the record as having opposed this change in earlier consultations and submissions and would encourage the Minister to reconsider his approach,” he said. 

“The planned removal of collaborative arrangement provisions will promote a siloed approach to care and ignores the explicit recommendation of the Medicare Benefits Schedule Review Taskforce , which said they needed to be retained and highlighted that removal of the requirement for collaboration would impact patient safety. 

“The current legislative provisions requiring collaboration are flexible and we have never considered them to be a barrier to participation of nurse practitioners and midwives in the workforce.” 

RACGP president Nicole Higgins told TMR that all primary care teams needed a GP and encouraged nurse practitioners to continue to work collaboratively with GPs. 

“GPs are the only trained medical specialists in whole-person care, from cradle to grave, which keeps Australians healthy and well,” she said. 

“The best quality and value model of primary care for Australian patients, the health system, and taxpayers is team care.” 

Part of the bill’s proposed changes stem from the Nurse Practitioner Workforce Plan committed to by the government in May of 2023. 

The plan proposed nurse practitioner-led prescribing and bulk billing with fewer limitations by 2026 and was contested by the AMA at the time

But among midwives and nurses, the response to the announcement, unsurprisingly, has been of a different tone. 

The Australian College of Midwives welcomed the introduction of the legislation set to 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 as a “great start” at this morning’s APNA-hosted, Kearney-sponsored 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,” she said.   

“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 “out-dated” and “unnecessary” requirement that she deemed “completely out of step with international best practice”. 

According to the DoHAC, the proposed changes follow the findings of “an independent review” that collaborative arrangements “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. 

Ms Kearney’s office did not reply to questions about why this bill had been introduced prior to the final report. 

The government is currently running a consultation into NP and endorsed midwife prescribing which is due to close on 1 April. 

Speaking to TMR, RANZCOG said it 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”. 

Should the bill pass, it would take effect as of 1 November this year. 

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