Nurse practitioners to fly free in WA pilot

4 minute read

Australia’s largest state will get $11 million over two years to fund 20 nurses to work ‘without a doctor looking over their shoulder’.

Nurse practitioners in Western Australia are set to break free from the limits of the MBS in a new extended scope-of-practice pilot.

Health Minister Mark Butler announced the program on Monday, confirming that the federal government had committed $11 million to the project.

The funding comes from the $100 million set aside in the October budget to “co-develop and pilot innovative models with states and territories to improve care pathways” in primary care before the rollout of 50 urgent care clinics.

Another $8 million of that funding has already been put toward a single-employer model for GP registrars in Tasmania.

The $11 million, to be delivered over two years, will pay for at least 20 nurse practitioners – that breaks down to $275,000 per nurse practitioner per year – to be employed in different primary care settings using their “full range of skills”.

General practice, Aboriginal Community Controlled Health Organisations, aged care facilities and other community health services will all be eligible locations for participating nurse practitioners.

Australian College of Nursing CEO Adjunct Professor Kylie Ward told The Medical Republic that the funding was welcome, and that Australians deserve high-quality healthcare in their local community.

“Giving nurses access to adequate funding in the primary and community setting is long overdue and essential for health equity and universal health care,” she said.

“If we are to ensure that all Australians can access quality health care regardless of their postcodes, particularly people who are marginalised and disadvantaged, we must do it together.”

In terms of what the expanded scope of nurse practitioners might look in practice, WA Health Minister Amber-Jade Sanderson said nurses might partner with a GP to take on aged care patients, or specialise in seeing walk-in wound care patients.

She also raised the possibility of nurses providing consults in pharmacies, and being able to provide scripts to patients in that setting.

Her federal counterpart was clear on the point that their scope of practice would be greatly increased.

“[These nurses will not] be constrained by limits in the Medicare Benefits Schedule as to what they might do without having a doctor looking over their shoulder,” Mr Butler said.

Mr Butler was confident that the nurse practitioners would prove valuable to communities and ease pressure on general practice.

“I’ve said on a number of occasions that at a time when demand for quality health care is soaring, it’s really skyrocketing in this country, but workforce is constrained, it just doesn’t make sense not to have everyone working to their full scope of practice,” he said.

“That is, using all of their skills, all of their training, rather than have that work constrained by outdated regulation and turf wars.”

The minister elaborated on his “turf wars” comment in a later interview, where he clarified that he was not specifically referring to doctors.

“This is a sector … with loud voices and sharp elbows,” he told ABC Radio.

The AMA has previously been at odds with attempts to expand the role of nurse practitioners, but supports their role as part of a team-based approach to managing health.

“While the AMA acknowledges that [nurse practitioners] can provide a valuable contribution to a multidisciplinary health care team, the AMA does not support proposals for [nurse practitioners’] access to the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme independent of a collaborative arrangement with a medical practitioner,” the association wrote in its 2022 position statement on nurse practitioners.

In the same position statement, the AMA warned that nurse practitioners were not a substitute for GP care and that their duties should not include unsupervised diagnosing, referring, ordering pathology, prescribing or deciding on patient hospital admission.

AMA vice president Dr Danielle McMullen told TMR that the organisation was waiting for more details on the WA program.

“However, if nurse practitioners were well integrated into existing primary care structures with strong clinical governance in areas of need it could help boost capacity,” she said.

“Team-based care with everyone working to their full scope in well-coordinated teams is the way of the future.”

RACGP president Dr Nicole Higgins said the college was concerned about the potential for role substitution.

“We support the role of nurse practitioners in integrated general practice teams, either co-located or external to the general practice location,” she told TMR.

“But failure to protect the current integrated general practice model risks wasting health resources through fragmentation of care and medical records, the potential for contradictory clinical advice, duplication of patient services, misdiagnosis or delayed diagnosis and inappropriate or delayed treatment.”

Dr Higgins also cited research that suggests nurse practitioners use more resources and achieve worse health outcomes than physicians.

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