RACGP disappointed with ‘denigration’ by nurses, midwives

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In a strongly worded joint response to the Scope of Practice Review, eight peak nursing bodies have denounced the way medicine is ‘historically prioritised and privileged’.

RACGP president Dr Nicole Higgins says she was disappointed that nursing bodies would denigrate the medical profession in an explosive joint submission to the Scope of Practice Review.

A group of eight nursing and midwifery organisations issued the statement today, urging the government to go even further on scope of practice and treat medicine as “equal” to other professions.

“In the past, there has been a tendency to treat medicine as separate and different from all other health professions, and thus to exclude them from requirements with which other [healthcare practitioners] have had to comply (see for example, the soon to be removed requirements for collaborative arrangements for nurses and midwives – a one-way ‘collaborative’ street),” the statement read.

“This has historically prioritised and privileged medicine, and disconnected medicine from the non-medical professions.

“The balance now needs to be restored.”

In fact, the group contended, it was the fees demanded by GPs that had created a mess in the Australian healthcare system.

“As a general principle … multidisciplinary teams do not need to be led by GPs, a false assumption circulated by the media, medical peaks and other platforms, driven by MBS billing arrangements rather than care needs of the person seeking treatment, and alluded to in [scope of practice review] Issues Paper 2,” they said.

“This expectation has led to the significant lack of access to and affordability of [primary healthcare] due to ever increasing costs imposed by GPs and is instrumental in the failure of the [primary healthcare] system in Australia.

“Further, this situation has led to increasing privatisation of the PHC system in Australia with too great a reliance on business-based models of care that are driven by profits and the production of personal wealth.”

Co-signatories to the statement, which was penned by University of Sydney Professor Emerita Mary Chiarella, included the Australian College of Nursing, the Australian College of Nurse Practitioners and the Australian Nursing and Midwifery Federation.

Dr Higgins told The Medical Republic that she was disappointed that nursing bodies would denigrate the medical profession and stressed that the best patient outcomes came when different practitioners collaborated.

“We support nurses and midwives working to the top of scope,” she said. “However, when done best that is usually narrow and specific; for example, the role of mental health nurses, or midwives managing perinatal care.

“Specialist GPs are trained differently and for much longer, we have a depth and breadth of scope of practice across the whole life journey covering all aspects of a patient’s physical and mental health.”

The nurses’ letter went on to claim that the rural and remote areas were losing out on access to healthcare because of how expensive it was to establish a GP clinic.

ACRRM views the situation differently.

In its submission to Issues Paper 2, released today, the rural college acknowledged that the current government funding for rural general practice was inadequate but warned against expanding scope for the sake of expanding scope.

“ACRRM supports all initiatives to broaden scope where this will improve access to high quality, safe services,” the submission read.

“There is an associated risk however, that this approach may see broadening of health practitioner scope being viewed as an end in and of itself, an approach which is likely to lead to frameworks being developed which are not reflective of the best interests of communities.”

Expensive though doctors may be, ACRRM said, the results of non-doctor led care will be even worse for communities.

“Another risk is that urban centric models encouraging a broadening scope of practice of health practitioners do not recognise the perverse consequence of rendering doctors or other key healthcare service providers financially unviable within a given rural community,” the rural college said.

“In these situations, unlike in cities, people in that community will not be able to catch public transport to a similar service in a neighbouring suburb and at a practical level may lose access to that service.

“This is particularly true for people who have high needs such as those with very low incomes, those who are aged, or those with debilitating medical conditions.”

The eight nursing and midwives organisations have also made individual submissions to the scope of practice review, which is due to report later this year. 

It’s led by health policy researcher Professor Mark Cormack, with the involvement of pharmacy academic Professor Lisa Nissen.

The latter is best known for her work evaluating Queensland’s pharmacist-led UTI prescribing trial.

At the RACGP’s recent Practice Owner’s Conference college president Dr Higgins said that, out of the 14 different reviews spurred by the Strengthening Medicare Taskforce, scope of practice was “the really important one”.

Behind patient safety, the biggest fear among medical practitioners is that expanded scope of practice for allied health workers is that the system will become fragmented and inefficient.

In response to these concerns the joint statement contended that it was nurses, not doctors, who are the hub of patient care.

“Medical professionals are neither the arbiters of, nor do they have a monopoly on, continuity of care,” it said.

“Indeed, there is a strong argument that, even in current practice … continuity of care is often facilitated by care navigator nurses, midwives and other nurses in the community, and nurse managers and clinical nurse consultants in hospitals.”

The latest round of Scope of Practice Review submissions closed in May.

Between July and September, the reviewers will be drafting the final report and holding another round of stakeholder forums.

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