The RACGP has issued a submission arguing against expanding MBS access for long-acting reversible contraceptives to endorsed midwives.
Medicare rebates for inserting and removing long-acting reversible contraceptives (LARC) should be reserved for “qualified practitioners”, regardless of how simple the procedure may appear, the RACGP has written in a new submission.
Earlier this year, the MBS Review Advisory Committee LARC working group released a draft report recommending that the government expand MBS access to endorsed midwives for hormonal implant and IUD insertion and removal.
Only midwives who have completed at least 5000 hours of clinical practice and additional post-graduate study can apply to be an “endorsed” midwife.
The MBS access would only extend to LARC insertion or removal for the purposes of contraceptive care and would not apply to complex removal involving anaesthesia.
“[Endorsed midwives] have access to the same training available to other providers wanting to train in insertion and removal of LARC, and these services are within their regular scope of practice,” the draft report said.
It’s also worth noting that the LARC working group is made up of two specialist GPs, two non-GP specialists, a health systems expert, a health economist and a consumer representative. There are no nursing or midwifery representatives on the team.
Nurse practitioners are already funded on the MBS for the insertion and removal of LARCs.
On Wednesday, the RACGP published its formal response to the draft report, pushing back on the recommendations.
“Given the invasive nature of LARC procedures, MBS item access should remain limited to qualified practitioners, with any future expansion contingent on clear evidence of equivalent training, competency, and safety,” the college said.
“Any practitioner performing these procedures must be held to the same standards of training, credentialling, indemnity and insurance as expected of other medical professionals.
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“Although LARC insertion may appear to be a simple procedure to some patients and non-medical practitioners, the RACGP highlights that it involves inherent clinical risks and may present substantial procedural complexity in particular circumstances or patient population risk.”
Instead, the college said, the commonwealth could expand access to comprehensive postpartum care by increasing the financial and logistical support for multidisciplinary, GP-led teams with endorsed midwives.
“Where non-medical practitioners perform these procedures in the primary care setting it must occur within the context of a multidisciplinary team including a medical practitioner to ensure continuity, ongoing, coordinated care, follow-up, and alignment with the patient’s broader health and fertility goals,” the RACGP submission read.
The MRAC review itself was requested in June 2024 by Health Minister Mark Butler. It is unclear when its final report is due.
