On the 20th of March the Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill was introduced to Federal Parliament by the Labor Government. This bill proposes the removal of barriers that prevent nurse practitioners and endorsed midwives from prescribing Pharmaceutical Benefits Scheme (PBS) medicines and providing services under Medicare.
Currently, nurse practitioners and endorsed midwives are prevented from autonomously providing services under Medicare and prescribing PBS medicines, without the supervision of a medical practitioner – known as a Collaborative Arrangement. An independent review found this legislated requirement creates several barriers to accessible, high-quality care for patients, particularly in rural and remote communities where it can be harder to see a doctor. The proposed amendment will remove these barriers that have held back highly educated nurses and midwives from operating to the full extent of their skills, training and experience. Subject to passage through Parliament, the change will come into effect from 1 November 2024.
We spoke to two PCNSW Members who are Nurse Practitioners to hear their thoughts on this Bill.
“I am in support for the removal of mandatory collaborative arrangements for Nurse Practitioners (NPs) as outlined in The National Health (Collaborative arrangements for NPs) introduced in 2010. While these arrangements were intended to facilitate access to Medicare and PBS benefits, they have proven to be restrictive and contradictory. As a Nurse Practitioner in palliative care, I have 20 years of palliative care experience, numerous tertiary degrees and prioritise ongoing education to be confident in this role as I am expected to work autonomously. While I am fortunate to have such supportive medical colleagues in the metropolitan area, the requirement for collaborative arrangements creates unnecessary roadblocks for NPs and in many ways causes delays and avoidable difficulties to provide care to patients.
The role of the NP has become increasingly important in bridging the gap between medical and nursing services. This recent move by the Commonwealth is a positive step towards better recognising and respecting our skillset. The collaboration relationship with medical team remains pivotal and should continue to grow closer and better, it is just that NP shouldn’t need to obey it as a one-sided written arrangement.
The ongoing reforms being reviewed in line with the 10-year NP Workforce Plan brings hope that similar legislation will soon follow. Removing unnecessary bureaucratic hurdles like this will allow NPs to practice to the full extent of their capabilities, ultimately improving patient access to essential healthcare services.” said Carmen Sanchez, PCNSW committee member and NP at Calvary Health Care Kogarah.
Larissa McIntyre, Chair of Palliative Aged Care Network (PACN) in NSW shares additional insights into the history of the current Collaborative Arrangements and additional thoughts on this Bill:
“It is very exciting to hear that the Collaborative Arrangement requirement could be lifted – for many it was poorly understood and is a barrier to patient choice in many ways. It will change how care is delivered by NPs. Imagine, in the palliative care space, if you could access a NP who could come to your home to provide care and be able to access this through Medicare. And have your medications covered under the Pharmaceutical Benefits Scheme (PBS). It would mean you, as the person, having greater choice and control.
The purpose of collaborative arrangements was to enable Nurse Practitioners (NP) and Participating Midwives to provide Medicare Benefits Schedule (MBS) funded services and prescribing rights to certain medications on the PBS. That was it.
It was never about being clinically supervised by a medical practitioner (MP) and MP are not medico-legally accountable for any element of the NP clinical practice. Although this was the interpretation that some had in the implementation of the legislation. And still have.
The arrangements were introduced in 2010 through the National Health (Collaborative arrangements for midwives) Determination 2010 and National Health (Collaborative arrangements for nurse practitioners) Determination 2010 under the National Health Act 1953. They were introduced as a prerequisite to a NP and Participating Midwife providing health care services subsidised by the MBS and to prescribe certain medications on the PBS.
The types of collaborative arrangements for a NP within the legislation are:
a) a collaborative arrangement in which the NP is employed or engaged by one or more medical practitioners (MP) or an entity that employs or engages one or more MP; or
b) a collaborative arrangement in which a MP refers a patient to the eligible NP in writing; or
c) a collaborative arrangement in which the eligible NP and one or more MP make an agreement in writing, signed by each party; or
d) a collaborative arrangement in which the eligible NP has acknowledgement from one or more MP that the practitioner will be collaborating in the care of a patient or patients and tells each patient to whom the arrangement applies that the NP will be providing care to the patient within an arrangement with one or more MP that provides for consultation, referral of the patient, transfer of the patient’s care and makes the required records in relation to each patient to whom the arrangement applies.
As you can see the administrative burden is quite high and again restrictive of NP running their own business.
It has always been about access to federally funded systems. For, example, prescribing medications via the PBS means a cheaper medication for the person – if there was no “Collaborative Arrangement” in place then the person would have a private prescription written which is more expensive. Same for accessing MBS the person would pay the fee charged by the NP instead of being bulk billed.
So, in many ways it has been a chain, if you like, that has restricted access to these systems – thereby restricting people’s choice as to who they consult. A NP who had no access to MBS or PBS or a MP who can access MBS or PBS? Who would you choose?
Nurses are collaborative in nature, our profession is founded on this factor. We have and will continue to work in collaboration with our health professional colleagues; whether they are speech therapists, psychologists, specialists, MP, social workers, pharmacists, other nurses and midwives – it is how we ensure that we are providing truly holistic care to the people who receive our care and services.” said Larissa McIntyre, Chair of Palliative Aged Care Network in NSW.
Access the full media release HERE for more information.
PCNSW will continue to keep our members updated on the progress of this Bill.