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
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.
Comments
6 responses to “Nurse Practitioners must be recognised by the Medical Benefits Schedule”
This is absolutely disgusting. Vomit-inducing.
There is just not any credible body which is not recommending the deeper participation of Nurse Practitioners in our Health system. Not least the overwhelming majority of this blog’s contributors.
This is an issue which is simply screaming – louder than Musk’s rockets – for Labor endorsement. Ethically, public interest and structurally.
Yet not a whimper from Labor since 2011. Not a bleat. Silence.
Does your doctor bully you, Anthony?? Does her/his professional association bully her/him (too)??
We are now in the second day of our New Year. OK. It’s still the ‘senseless season’. We’ve got some weeks to go before our ‘sensible season’ resurrects.
If Labor does not propose this reform within the first week of ‘prime time’ ratings (the advent of the ‘sensible season’), Labor is telling all of us that Labor is still not fit to govern. God won’t help Labor – nor us. And not just because he doesn’t exist!!
NP should be a step on the road to becoming a full Doctor.
There is clearly misogyny in the profession.
Innovation is necessary as there are far too many non poisonous treatments that are discounted by the ‘profesionals’. The grasp of the profession on healing must be challenged, with sound results.
We need more details about the case being proposed here
Three articles in 2 days. What are those 14 recommendations, and were they rejected because of vested interests as claimed by NPs or is this blog suffering the same illness it is trying to treat in our fake-news selective-facts world?
So far, I am unconvinced. I have been a beneficiary of a NP’s care and have had cause to be truly thankful for the less experienced and trained nurses lower down in the nursing hierarchy, so please read the next paragraph bearing in mind I would very much like to see NPs take a much bigger role and be better recognised both financially and for their expertise in Australia.
Summarising the articles I’ve read here, NPs seem to be claiming they should be paid by Medicare (ie, taxpayers like moi) because
(a) they have achieved specialist expertise after decades of on-the-job training and experience – glossing over the fact that this expertise and training depend very much on having specialist doctors and units operating as they are now, not after they’ve been hollowed out like GPs have been hollowed out since the 70s and now suffer a self-fulfilling cycle of criticism and fall in standard; or
(b) they can provide an adequate (but obviously less comprehensive though presumptively preferable to comprehensive) service in their (personally-specific) area of interest at a lower cost – despite the obvious contradiction on which this argument predicates namely specialist decades-trained NPs demanding better pay will provide cheaper and better services in underserviced areas; why not just invest in telehealth and train up regular nurses?
The perspective I am getting from these articles is similar to the perspective I get of the Pharmacy Guild’s argument (or the building industry, or the coal lobby, or the US-paid institutes and centres in Australia that this blog rails against) for their right to the low hanging fruits while completely ignoring the bigger picture and consequences for taxpaying voters like me.
If this isn’t part of the 14 recommendations, my layman’s suggestion would be for NPs to stop attacking the doctors as if they have a chip on their shoulders (which is the impression that these articles give) and just do what the psychologists, physios, chiropractors and podiatrists do – they are specialists in their trade and are rightly paid by Medicare as such (rather than do what pharmacists do, demand recognition as doctors and end up with a few very rich pharmacists or pharmacy-owners and a majority of underpaid highly-trained-poorly-utilised professions).