Nurse Practitioners must be recognised by the Medical Benefits Schedule

For the sake of improved nationwide health care delivery, in its eventual response to the MBS Review, we sincerely hope that government is able to demonstrate an enlightened approach to the role of Nurse Practitioners in Australia.

Twenty years ago, the first Nurse Practitioner (NP) was endorsed in NSW. This historic step came after a protracted yet collaborative public policy process with the main resisters and antagonists originating in the medical profession and their representative organisations. Since 2000, leading the way across Australia have been state governments, establishing NP roles in the public sector. Gradually over the last two decades, there has been steady growth of practicing NPs in private practice settings and contexts such as residential aged care.

Research has demonstrated the positive contribution NPs are making to health care outcomes across Australia. However, an area that has constrained the potential contribution of NPs has been a restricted list of costs subsidised as part of the Medical Benefits Schedule (MBS). Recognising that there continues to be some resistance to NPs the recent Review of the Medical Benefits Schedule still gave some small measure of hope that at least some of the restricted MBS subsidy issues experienced by NPs might be addressed.

The establishment of the Nurse Practitioner Reference Group (NPRG) – the role of which was to explore and develop evidence-based recommendations to the Medical Benefits Schedule Review Taskforce (MBSRT) was a positive step. The NPRG membership included NPs, medical practitioners and consumers and after many meetings and much discussion, 14 recommendations were developed.  That all 14 recommendations have been swept aside by the Medical Benefits Review Taskforce and replaced by three of its own recommendations – developed without any consultation beyond the Taskforce – is breathtaking.

The MBSRT itself was comprised of one consumer, a health economist and 14 medical practitioners[1]. That composition brings into question the appropriateness of having one of the primary Australian health care funding systems being reviewed by the very people that stand to financially suffer or gain the most from the Review.   Certainly, stakeholders who have a high level of investment need to be involved, however if improvements in health care are to be achieved, the contributions of all health professionals and consumers must be equally respected and valued.

This fundamental yet often overlooked issue, stands in stark contrast to how the power, political influence and medical dominance generally, commercially protects one group of health care providers through its influence on public policy outcomes. It is important to note it is Australians who, across a vast geographical landscape, are in need of health care which should place their needs and access to services at the very centre of deliberations. Indeed, the Taskforce’s raison d’etre is the health needs of all Australians yet the abandonment of the NPRG’s 14 recommendations to the Taskforce seems bereft of that priority.

This year has highlighted the importance of nurses and other health care workers as the pandemic has impacted globally on all health systems. Teamwork – by definition ‘collaboration’ – by these health professionals has been critical to the care and management of those suffering from COVID-19. Collaboration and teamwork are words which nurses, especially NPs, already live by each and every day. NPs do not seek to usurp medical practitioners but to work alongside and with them in a collegial, professional, relationship

The MBS Taskforce refers to the need for ‘innovation’ in health care delivery and we would agree that this is critical if we are to continue to have the best health system possible. In doing so, there is a need for all professions to recognise and value the contribution that each has to make and move away from outdated views that trade on hierarchy and control.

Witness that during this pandemic, in other countries such as the US and in Europe there have been examples of the role of nurses being extended. A case in point, in the US several states have removed previous restrictions on NPs to enable them to fully practice[2].  Yet in Australia, the exact opposite appears to be unfolding. The rejection of the NPRG recommendations represents a move to further restrict and limit the role of NPs. The MBS Review Taskforce appears to have stepped outside its remit and taken an opportunity to try and undo 20 years of safe Nurse Practitioner health care service delivery.

The political environment during the public policy development in Australia (in the 90s in NSW initially), has been highlighted by a constant theme of bipartisanship. This perhaps reflects the reality that – regardless of right or left ideologies – health care systems must strive for the best health care outcomes for citizens in an efficient and equitable manner. Such outcomes, to a very large extent, hinge on access to high standards of care and Nurse Practitioners remain poised to more greatly assist with providing Australians with such access.

For the sake of improved nationwide health care delivery, in its eventual response to the MBS Review, we sincerely hope that government is able to demonstrate an enlightened approach to the role of Nurse Practitioners in Australia. – a response which should see, like in many settings around the world, an enhanced role for Nurse Practitioners in health care delivery to people in need. Otherwise, we can only conclude that centuries after his analysis was published, Machiavelli is right again.

[1] https://www1.health.gov.au/internet/main/publishing.nsf/Content/MBSR-members

[2] https://journals.lww.com/ajnonline/fulltext/2020/08000/covid_19_brings_changes_to_np_scope_of_practice.7.aspx

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Professor Debra Thoms former Commonwealth CNMO (2015 - 2019) and currently Acting Head of School, Nursing at Queensland University of Technology.

Dr Leanne Morton - in her PhD explored the policy process and settings for the introduction of Nurse Practitioners into Australia.

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