AMA response to nurse practitioner and midwife legislation

29 Jul 2009

In the 2009/10 Federal Budget, the Government announced that it would move to allow some nurse practitioners and midwives to provide services funded under the Commonwealth Medicare Benefits Schedule (MBS) and to prescribe medications that are subsidised under the Pharmaceutical Benefits Scheme (PBS).  It also announced that the Commonwealth would subsidise indemnity insurance for midwives, although it decided not to extend this cover to home births.

The Government recently introduced three Bills into the Parliament to implement its Budget announcements. These are the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009.

These Bills have been referred to a Senate Community Affairs Legislation Committee Inquiry and the AMA has provided a detailed submission to this Inquiry. The AMA submission highlights that, if implemented carefully, the legislation may help address unmet community health needs - provided it is done in a coordinated way and medical practitioners are still involved in the overall care of the patient. The AMA has warned the Committee that if the legislation is not implemented carefully, it will fragment care, increase the risks of inadvertent patient outcomes, cause duplication and increase costs.

The AMA submission outlines detailed recommendations designed to ensure that the ultimate arrangements work in practice and patient safety is safeguarded.

A key feature of the AMA's submission is our call for the Bills to be amended to guarantee that nurse practitioners and midwives will collaborate in a meaningful way with doctors in the care of patients. The AMA has proposed that if nurse practitioners and midwives wish to provide MBS funded services or prescribe PBS subsidised medicines they must enter into a "collaborative care agreement" with the patient's usual GP or a doctor nominated by the patient. This proposal is designed to ensure that patient care does not become fragmented and that patients have guaranteed access to a medical diagnosis and ongoing support.

The AMA has also proposed the establishment of a Care Collaboration Advisory Panel, that will provide advice to the Minister for Health and Ageing about the implementation and ongoing operation of the legislation, as well as the establishment of the Health Profession Prescribing Committee - which will evaluate and advise government on any proposal to allow nurse practitioners and/or midwives to prescribe medications.

The AMA has stressed the need for the impact of the legislation to be properly evaluated over time. The submission highlights that there is a lack of evidence to support the substitution of doctors with other health professionals and that there are inherent risks in doing so. In this context, the AMA has recommended that the Bills should be amended to include a formal requirement for the Minister for Health and Ageing to commission an independent evaluation of patient outcomes in terms of access, mortality and morbidity and the effects on the cost of care provision resulting from these new arrangements and to provide this evaluation to Parliament no later than four years from its date of commencement. This evaluation should cover all matters related to the operation of the legislation including the impact on health system costs, the quality and safety of care, access to care, workforce impacts and operational issues.

The full copy of the AMA submission can be downloaded at the link below.